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Principles  and  Technique 

OF 

Crowns  and  Bridges 


By 
J.   F.   HOVESTADT.  D.M.D. 

Instructor  in  Crown  and  Bridge  Work,  Harvard  Dental  School,  Harvard 
University 

Former  Vice-President   of    the   Massachusetts  Dental   Hygiene  Council 

Member  of:  Harvard  Odontological  Society 
Massachusetts  Dental  Society 

First  District  Dental  Society,  State  of  New^  York 
National  Dental  Association 


BOSTON,    MASSACHUSETTS 

RITTER  &  FLEBBE 
120  BOYLSTON  STREET 


(The  right   of  reproduction   of  the   original  illustrations  is 
strictly    reserved.) 

Copyrighted  at  the  Registry  of  Copyrights,  Wasliington,  D.  C,  igiS 
All  rishts  reserved. 


CONTENTS 


I.     INTRODUCTION ""l 


II.     EXAMINATION    AND    STUDY     OF 

GROWN  AND   BRIDGE   GASES    .    .  11 

III.     GLASSIFIGATION    OF    GROWN   AND 

BRIDGE  GASES 13 

A.  AS  TO  HEALTH  AND  PATHOLOGI- 
CAL CONDITIONS  OF  THE  TEETH 
AND  MOUTH 13 

1.  Septic  roots 13 

2.  Acid  mouth  and  erosion     ....  15 

3.  Pyorrhoeatic  condition 15 

4.  Absorption  of  tissue 18 

B.  AS  TO  OCCLUSION 20 

1.  Normal  occlusion 20 

2.  Sufficient  occlusion 20 

3.  Mal-occlusion 21 

a.  Lack  of  contact  points     ...  22 

b.  Teeth  tipped  forward      ...  22 

c.  Teeth  elongated 24 

d.  Temporary  teeth  retained          •  26 

e.  Closed  bite 27 

f.  Maxillary  and  mandibular]  pro- 

tusion 29 

g.  Wandering  teeth ^^ 

h.     Irregularly  arranged  teeth   .      •  33 


CONTENTS 


IV.  PRELIMINARY  TREATMENT  OF  THE   p,,e 

MOUTH  AND  TEETH 37 

1.  Prophylactic  treatment 37 

2.  Exodontia 37 

3.  Pyorrhoea  treatment 37 

4.  Devitalization  of  healthy  teeth     .  37 

5.  Treatment  of  teeth  with  pathological 

pulps 38 

a.  Treatment  from  root  canals      .  38 

b.  Treatment  from  alveolar   side, 

surgically 42 

6.  Building  up  of  decayed  and  broken- 

down  teeth 43 

V.  ORAL   ANAESTHESIA 44 

A.  INSTRUMENTARIUM 44 

B.  DRUGS 47 

G.     PREPARING  OF   SOLUTION   ...  47 

1.  For  normal  cases 48 

2.  For  deep  anaemia 48 

3.  For  abnormal  cases 48 

D.  PREPARING   OF    PLAGE    FOR    IN- 

SERTION OF  THE  NEEDLE      .  49 

E.  INFILTRATION  METHOD  ....  49 

1.  Injection  in  buccal  and  labial  side  of 

maxillary  teeth      ....  51 

2.  Injection  on  labial  side  of  lower  in- 

cisors    52 

3.  Injection  on  palatal  and  lingual  sides  •  52 

F.  CONDUGTIVE  METHOD     ....  54 

1.  Pterygo-mandibular  injection  ...  54 

2.  Buccinator  injection 57 

3.  Zygomatic  injection  ......  57 

4.  Infra-orbital  injection 58 

5.  Incisive  injection 58 

6.  Post  palatine  injection 59 

G.  AFTER-EFFEGTS 59 

PULP  REMOVAL:   PRESSURE  ANAES- 

THESIA 59 

TREATMENT    FOR    HYPERSENSITIVE 

DENTIN 60 


CONTENTS 


Page 


VI.     GENERAL    TECHNICAL    MANIPU- 
LATION        61 

1.  Selecting  shade 61 

2.  Taking  bite 61 

3.  Taking  impression 61 

4.  Mounting  a  Grown  and  Bridge  case 

on  articulator 63 

Selecting  of  teeth 64 

Grinding  of  teeth 64 


5. 

6. 

7. 

8. 

9. 
10. 
11. 
12. 
13. 
14. 

15. 
16. 
17. 

18. 


Backing  of  teeth 65 

Reinforcing  or  backings      ....  66 

To  prevent  cracking  of  facing  ...  67 

Soldering  bridge  in  sections    ...  69 

Gasting  . 70 

Polishing 72 

Gold  plating 73 

Fitting  bridges  in  mouth  and  wearing 

them 74 

Cementing 75 

Final  adjustment  of  occlusion  76 

Instruction  to  patients  .....  76 

Care  of  bridges 77 


VII.     SINGLE  CROWNS 

ALL  PORCELAIN   CROWNS 

Crown  I  1.    Jacket  crown 

2.  Detached  post  crown 

Crown  II  Detached  carved  crown 

Grown  III  Detached  stock  crown   . 


78 

78 

78 
81 
81 
82 


PORCELAIN  CROWN  WITH  METAL 

BASE 88 

Crown  IV  1.     Porcelain  baked  crown  with  platinum 

base 88 

Grown  V  2.     Porcelain  crown  with  cast  base     •     .  89 

Direct  Method 89 

Indirect  Method 90 


CONTENTS 


Crown  VI 
Grown  VII 

Grown  VIII 


Grown  Via 
Vila 
Villa 


BANDED   GROWNS 92 

I.    Base  for  Banded  Growns      .     .  93 

Direct  Method 93 

1.  Soldered  caps 93 

2.  Burnished  caps 95 

Indirect  Method      .      .      ...      .96 

3.  Swaged  caps 96 

II.    Supplies  for  Banded  Growns   .  97 

a.     With  facings 97 


Grown  VIb 
Vllb 
Vlllb 

Grown  Vic 
VIIc 
VIIIc 


b.     With  detached  post  crowns 


c.     With  Goslee  teeth 


98 


100 


Grown  VId 
Vlld 
Vllld 


d.     With  Steele  teeth 


101 


Grown  IX 

1. 

Grown  XI 

3. 

XIa 

Xlb 

Grown  XII 

4. 

Grown  XIII 

5. 

Grown  XIV 

6. 

ALL-METAL  GROWNS  .     .     . 

Open-faced  crowns — glove  fit 
Two-piece  all-metal  crowns 

a.  With  swaged  cusps    . 

b.  With  cast  cusps 
Seamless  pressed  crowns   • 
Seamless  swaged  crowns    . 
Growns  with  porcelain  facing 


102 

102 
105 
106 
107 
108 
113 
118 


CONTENTS 


Page 

VIII.     FIXED  BRIDGES 119 

A.  ABUTMENTS  FOR  FIXED  BRIDGE- 

WORK  119 

A.  Inlay  Abutments 119 

Abutment  I            1.     Inlays  with  posts  or  M.  O.  D.  inlays  .  119 

B.  Banded  Grown  Abutments  .     .  122 

I.  BASE    FOR    BANDED    ABUTMENTS      ...  122 

Abutment  II            1.     Soldered  caps 122 

Abutment  III           2.     Burnished  caps 122 

Abutment  IV          3.     Swaged  caps 122 

II.  SUPPLIES   FOR   BANDED   ABUTMENTS    .       .  122 

Abutment  Ila-IIIa-lVa    a.     With  facing 122 

Abutment  Ilb-IIIb-IVb  b.     With  detached  post  crown.  122 

Abutment  IIc-IIIc-IVc    c.     With  Goslee  tooth     ....  122 

Abutment  Ild-IIId-IVd  d.     With  Steele  tooth 122 

C.  All-Metal  Abutments       ...  123 

Abutment  V            1.     Half  crown  with  post 123 

Abutment  VI          2.     Staple 124 

Abutment  VII        3.     Open-faced,  glove  fit 126 

Abutment  VIII       4.     Open-faced,  other  methods           .  126 
Abutment  IX          5.     Two-piece  all-metal  crown 

Swaged  cusps 126 

Cast  cusps 126 

Abutment  X            6.     Seamless  pressed  crown      ....  126 

Abutment  XI          7.     Seamless  swaged  crown       ....  126 

Abutment  XII         8,     Grown  with  porcelain  facing    .      .      .  126 

B.  SUPPLIES  FOR   BRIDGEWORK   .     .  126 

Supply  I                   1.     Gast  supplies 127 

Supply  II                  2.     Facings  with  double  backings        .     .  128 

Supply  III                3.     Facing  with  backings  and  swaged  cusps  128 

Supply  IV                4.     Detached  post  crowns 130 

Supply  V                 5.     Steele  facings 130 

Supply  VI                6.     Steele  posterior 131 

Supply  VII              7.     Goslee  teeth 134 

Supply  VIII            8.     Evslin  interchangeable  teeth  136 


CONTENTS 


Page 

C.     ASSEMBLING  BRIDGES 137 

Bridge  I                    1.     Sanitary  bridges 137 

Bridge  II                      a  With  gold  chewing  surface.      ...  137 

b  With  porcelain  chewing  surface    .  138 

Bridge  III                2.     Self-cleansing  bridges 138 

Bridge  IV                3.     Saddle  bridges 140 

With  continuous  saddles      ....  140 

Bridge  V                        With  porcelain  saddles 142 

With  individual  saddles 143 

Bridge  VI                4.     Extension  bridges 144 

Bridge  VII               5.     Interlocking  two-piece  bridges  144 

Dove-tail  attachment 144 

IX.  REMOVABLE   BRIDGES 145 

A.     Gilmore  attachments  145 

General  description  of  technique  145 

Preparing  caps  and  posts 145 

Fitting  platinized  gold  wire 147 

Bridge  I                   1.     Full  bridges 156 

Bridge  II                2.    Short  bridges 158 

Bridge  III                3.     Partial  bridges  with  vault  bar    .      .     .  158 

Bridge  IV               4.     Partial  bridges  with  lingual  bar      .     .  160 

Bridge  V                 5.     Extension  bridges 160 

Bridge  VI     B.     Removable    bridges    with    Roach    attach- 
ment         168 

Bridge  VII   C.     Removable    bridges    with  Morgan  attach- 
ment         169 

X.  REPAIR  OF  CROWNS  AND  BRIDGES  174 

1.  For  temporal  use 174 

2.  For  permanent  use 177 

Ash  repair  outfit 178 

Steele  repair  outfit 179 

Bryant  bridge  repair  tools  ....  180 

Another  method 180 

Mineral  stains 182 

Special  instruments 182 

XL     PRACTICAL  CASES 185 


I.     INTRODUCTION 

IT  is  the  author's  aim  to  give  in  this  book  a  practical, 
systematic  and  condensed  description  of  the  technique  of 
Crown  and  Bridge  work. 

The  book  is  specially  written  for  the  student,  and  the  prac- 
titioner, who  has  had  little  experience  in  this  branch  of  our 
profession,  to  help  him  restore  the  vital  function  and  character- 
istic beauty  of  the  masticating  apparatus. 

Realizing  the  great  importance  which  so  often  is  overlooked, 
to  make  a  careful  study  of  a  mouth,  so  as  to  be  able  to  follow 
a  definite  plan  of  restoration,  the  author  has  tried  to  make  the 
less  experienced  reader  acquainted  with  mal-occlusion  resulting 
from  the  loss  of  teeth,  which  have  not  been  replaced,  and  mal- 
occlusion in  the  adult  resulting  from  other  reasons.  Also  the 
condition  of  the  teeth,  to  serve  as  abutments,  should  receive 
close  attention.  As  it  would  be  unwise  to  build  a  beautiful 
new  house  on  an  unsafe  foundation,  so  it  would  be  condem- 
nable  to  use  unhealthy  teeth  or  roots,  as  abutments  for  a  bridge. 
The  author  therefore  will  also  bring  close  attention  to  such 
conditions,  and  point  out  the  importance  of  making  careful  ex- 
aminations of  such  teeth,  which  should  be  extracted  if  they 
do  not  yield  to  treatment. 

BridgeAvork  as  a  rale  recjuires  the  most  extensive  reduction 
of  the  shape  of  the  teeth  and  if,  after  careful  study,  it  is  found 
necessary  to  devitalize  a  tooth,  one  can  accomplish  this  in  no 
other  way  with  such  ease,  with  so  little  pain,  and  so  much 
saving  of  time,  as  with  the  aid  of  "Local  Anaesthesia,"  the 
importance  of  which  has  not  yet  been  sufficiently  recognized, 
and  therefore  a  very  condensed  chapter  on  "Local  Anaesthe- 
sia," an  extract  from  Dr.  K.  H.  Thoma's  book  "Oral  Anaes- 
thesia," has  been  added  by  special  arrangement  with  my  es- 
teemed friend  and  co-worker. 

Crown  and  fixed  bridge  work  will  then  receive  our  atten- 
tion. The  technique  is  given  in  step  form,  with  illustrations  to 
make  it  as  simple  as  possible  to  follow,  one  after  the  other, 


10  INTRODUCTION 


the  steps  of  construction.  The  author  considers  well-con- 
structed fixed  bridgework  the  best  known  replacement,  as  it 
is  closest  to  AA^hat  nature  intended  us  to  have.  However,  the 
cases  must  be  properly  selected.  Eemovable  bridges  help  us 
in  many  cases  to  overcome  conditions,  Avhich  are  unfavorable, 
and  unpractical  for  fixed  bridges,  and  these  render  it  possible 
in  many  cases  to  give  the  patient  a  satisfactory  and  comfort- 
able appliance,  especially  when  it  would  be  almost  impossible 
to  get  a  good  result  with  a  plate. 

The  author's  experience  is  based  upon  twenty-seven  years 
of  practical  work,  conducting  his  own  laboratory,  as  AA^ell  as 
directing  the  work  for  other  practitioners,  consisting  chiefly 
of  metal  and  porcelain  work.  During  this  long  period  of 
private  practice  and  seven  years  of  teaching  in  the  Crown  and 
Bridge  Department  of  Harvard  Dental  School,  the  different 
methods  have  been  given  the  most  careful  tests.  The  principal 
aim  is  to  give  the  inexperienced,  |a  reliable  guide,  and  it  is  the 
author's  sincere  hope  and  wish  that  the  reader  may  benefit 
humanity,  through  knpwledge  received  from  this  book,  and 
receive  in  return  the  appreciation  of  his  patients. 


II.     EXAMINATION    AND 

STUDY  OF  CROWN  AND 

BRIDGE  CASES 

It  is  of  greatest  value  that  the  entire  mouth  should  be 
studied  when  a  case  presents  itself  for  Crown  and  Bridge  work. 
Too  many  men  let  themselves  be  influenced  by  patients  desir- 


FiG.   1.     These  two  cases   show  the  result  of   work  done  without  the  help   of 

Radiographs. 

ing  to  improve  their  appearance,  and  therefore  asking  for 
replacement  of  some  particular  teeth  only,  disregarding  con- 
ditions in  the  masticating  region,  which  are  of  much  greater 
importance.     It  is  the  dentist's  duty  to  point  out  the  double 


12  CROWDS  AND   BRIDGES 

advantage  of  restoring  the  normal  occlusion.  Not  only  should 
hopeless  teeth  be  extracted,  sufficient  roots  treated,  cavities 
filled,  but  the  posterior  teeth  should  be  replaced  first  of  all,  to 
give  the  patient  the  possibility  to  masticate  and  in  this  fashion 
improve  his  general  health.  Beside  the  improvement  of  health 
and  efficiency,  we  have  another  reason  which  is  very  closely 
associated  with  the  operator's  success.  If  teeth  are  only 
restored  by  bridges  in  parts  of  the  mouth,  while  spaces  remain 
in  others,  we  get  abnormal  pressure,  and  abnormal  force  ap- 
plied upon  the  artificial  appliances,  shortening  the  time  of 
service  of  their  abutments.  A  dentist  is  therefore  more  than 
justified  to  refuse  treatment,  if  the  patient  does  not  commit 
himself  to  the  operator's  advice. 

As  in  orthodontia  so  in  Crown  and  Bridge 
Models  work,    it   is   most    satisfactory    to    study    a 

mouth  with  the  aid  of  plaster  models.  It  is 
not  only  much  easier  to  study  the  conditions  on  models,  but 
these  will  be  a  help  to  consult  and  advise  the  patient.  Finally 
they  will  be  a  record  of  the  primary  condition  of  the  mouth. 

The  teeth  to  be  used  for  abutments,  should 
Radiographs        be  carefully  studied.     The  condition  of  the 

pulp,  direction  of  the  roots,  number  of  roots 
and  canals,  and  in  devitalized  or  septic  teeth  the  condition  of 
the  apex  should  be  ascertained.  In  pyorrhoeatic  cases,  we 
should  know  how  much  of  the  process  has  been  absorbed.  All 
this  is  easily  done  by  radiographs,  which  give  us  a  good  idea 
beforehand  how  strong  the  fundamentals  are  upon  which  we 
base  our  work. 


III.    CLASSIFICATION    OF 

CROWN  AND  BRIDGE 

CASES 

We  can  classify  a  nioiitli  in  two  ways: 

(a)    Pathological  conditions  of  the  teeth  and  mouth. 
(h)    In  regard  to  occlusion. 

A.      PATHOLOGICAL  CONDITIONS  OF  THE  TEETH 

AND   MOUTH 

Patients  needing  bridgework  have  usually  brought  about 
the  loss  of  teeth  by  negligence  of  their  mouth,  and  we  there- 
fore frequently  find  their  teeth  in  very  bad  condition. 

Often  we  find  diseased  teeth,  and  we  have 
1.     Septic  to  decide  just  what  teeth  should  be  saved, 

Roots  and  what  teeth  should  be  extracted.     To  de- 

cide this  question,  we  must  consider  that  a 
tooth  has  a  relative  value.  If  there  are  plenty  of  good  abut- 
ments, we  will  condemn  a  tooth,  with  a  chronic  alveolar  ab- 
scess, which  has  given  trouble  from  time  to  time,  but  in  case 
of  scarcity,  it  would  be  important  to  treat  this  tooth,  even  if 
it  involves  a  long  and  tedious  process.  For  example,  it  might 
be  of  practical  value  to  save  even  one  root  of  a  tooth,  if  it  is 
healthy,  to  be  used  as  an  abutment,  as  the  palatal  root  of  an 
upper,  or  the  mesial  or  distal  root  of  a  lower  molar.  (Figure 
2.)  These  surrounded  by  healthy  tissue,  give  in  most  cases  as 
equally  good  service  as  any  single  rooted  teeth.  We  should, 
however,  be  careful  in  our  diagnosis  and  treatment.  Cause 
and  result  of  treatment  should  be  ascertained  by  the  X-ray, 
and  teeth  which  do  not  yield  to  treatment  should  be  extracted. 
(See  Figure  3.) 


Fig.  2.     Mesial  root  of  an  inferior  six-year  molar,  used  as  an  abutment.     The 

distal  root  of  this  six-year  molar  was  amputated  on  account  of  chronic  abscess. 

Above,  radiograph ;  below,  model  of  the  case. 


Fig.  3.     Pathological  conditions  of  the  teeth.     Radiographs  of  teeth  and  roots 
which  had  to  be  extracted  on  account  of  chronic  abscesses  and  failure  of  root 

canal  treatment. 


CLASSIFICATION 


15 


If  roots  or  teeth  are  hopeless  on  account  of  their  patholog- 
ical conditions  or  on  account  of  their  position  or  direction,  we 
decide  on  their  removal.      (See  Figure  3.) 

Certain  crowns    (and  inlay  abutments)    are 

2.  Acid  Mouth  contra-indicated  in  an  acid  mouth;  these  are 
and  Erosion  half  crowns  with  post,  open-faced,  and  staple 

crowns.  It  is  important  to  have  all  abut- 
ments extending  under  the  gum,  to  eliminate  as  far  as  possible 
further  attack  of  deca}^  and  the  dissolving  of  the  cement,  which 
is  used  for  setting. 

A  great  many  of  the  cases  which  we  examine 

3.  Pyorrhoeatic  have  pyorrhoea  tic   teeth,  and  these  are  the 
Condition  most  difficult  ones  to  diagnose  and  prognose. 

Some  teeth  usually  have  to  be  sacrificed, 
others  can  be  treated  in  the  regular  way,  and  still  others  may 


Fig.  4.     Pathological  conditions  of  the  mouth.     Radiograph  showing  absorption 
of   the   alveolar  process,   caused   by   pyorrhoea   alveolaris. 


be  found  sound.  Kadiographs  give  us  a  good  idea  of  the 
amount  of  absorption  that  has  taken  place  in  the  alveolar  proc- 
ess, and  which  teeth  are  strong  enough  for  bridge  abutments. 
(Figure  4.) 

When  treating  pyorrhoeatic  teeth,  the  first  and  most  im- 
portant is  correction  of  the  occlusion.  Many  teeth  will  tighten 
in  a  surprisingly  .short  time,  if  the  strike  is  relieved  to  give 
them  a  chance  to  rest  and  recuperate.  It  is  advisable  in  many 
cases  to  devitalize  pyorrhoeatic  teeth,  and  if  they  are  to  serve 
as  abutments  to  cut  them  off.  By  extirpating  the  pulp  of  such 
a  tooth,  we  increase  the  circulation  in  the  alveolo-dental  mem- 


16 


CROWNS  AND  BRIDGES 


brane,  which  then  receives  the  entire  suppl}^  of  the  dental  ves- 
sels. Cutting  these  teeth  off,  even  with  the  gum,  will  improve 
the  condition  for  two  reasons:  first,  it  gives  the  teeth  the  im- 
portant surgical  rest;  and  second,  if  used  as  abutments  for 
the  bar  in  removable  bridges,  it  decreases  the  lever  action. 

The  next  step  to  decide  upon  is,  what  appliance  should  be 
used.     For  phyorrhoea  cases  are  recommended: 

{a)   Bridges  without  bands. 

(5)   Bridge  splints. 

(c)   Removable  bridges. 


Fig.    S.     Pyorrhoeatic    condition.     Bridge    splint. 

(a)  Bridges  without  bands.  If  there  is  but  little  absorp- 
tion of  the  process  with  large  and  persistent  pockets,  or  if 
bridges  have  to  be  made  before  the  teeth  can  be  cured,  it  is 


CLASSIFICATION 


17 


advisable  to  coiistrnct  tliem  in  a  manner  Avliicli  does  not  inter- 
fere with  the  scaling-  and  cnretting-.  Therefore  use  abutments 
without  bands,  snch  as  inlays,  lialf  croAvns,  bandless  crowns, 
etc. 

(b)  Bridge  splints.  These  are  used  if  mastication  causes 
abnormal  stress  on  the  teeth,  or  on  wandering  teeth.  Tlie 
process  and  gum  has  receded,  and  the  free  part  of  the  tooth  is 
out  of  proportion  to  the  part  that  retains  the  tootl)   in   the 


Fig.  6.  Pyorrhoeatic  condition.  Lower  picture  shows  tlie  condition  before  the 
treatment;  a  great  deal  of  tissue  has  been  absorbed,  and  the  lever  action  on 
the  part  of  the  tooth  extending  out  of  the  gum  is  great.  Upper  picture  shows 
the  roots  cut  flush  with  the  gum  and  connected  with  a  bar,  which  also  acts  to 
hold  a  removable  bridge. 


socket,  the  lever  action  on  tlie  teeth  in  mastication  has  to  be 
counteracted,  the  teeth  have  to  receive  a  support  to  put  them 
at  rest,  which  is  brought  about  by  fixing  them  together  Avith 
an  appliance  called  a  splint.  Missing  teeth  can  be  replaced  by 
adding  them  to  the  appliance.      (Figure  5.)      It  is,  however. 


18  CROWNS  AND  BRIDGES 

important  to  keep  in  mind  tliat  a  splint  is  not  a  cure  for  pyor- 
rhoea, bnt  only  a  device  to  do  two  things: 

1.  Assist   the  healing   process,   allowing   new   bone  to 

form,  by  giving  the  teeth  a  surgical  rest.     It  may 
be  used  only  as  a  temporary  appliance. 

2.  To  hold  very  badly  affected  teeth  in  place  and  pre- 
vent them  from  getting  worse.  These  splints 
usually  preserve  the  teeth  for  a  number  of  years. 
A  splint  of  that  sort  is  called  a  bridge  splint.  It 
should,  however,  be  so  constructed  that  it  does  not 
interfere  with  prophylactic  treatment  b}^  the  pa- 
tient, and  pyorrhoea  treatment  by  the  operator, 
which  should  be  continued  at  regular  intervals. 
(Figure  5.) 

(c)  Removable  bridges.  If  a  great  amount  of  tissue  has 
been  absorbed,  which  we  find  necessary  to  fill  in,  or  where 
there  are  but  a  few  abutments,  we  find  the  most  satisfactory 
restoration  in  a  suitable  removable  bridge.     (Figure  6.) 

The  teeth  are  cut  off  flush  with  the  gum,  which  does  away 
with  the  lever  action,  and  gives  the  remaining  end  of  the  root 
a  much  better  chance.  The  roots  are  capi)ed  and  held  in  their 
position,  this  again  strengthens  them,  while  the  stress  of  mas- 
tication is  partly  taken  up  by  the  saddle  support  on  the  gum. 
These  appliances  also  have  the  advantage  that  the  patient  can 
take  them  out,  and  clean  them,  and  what  is  of  still  greater 
importance  there  is  easy  access  to  the  roots  for  prophylactic 
treatment. 

A  great  amount  of  tissue  may  be  lost  in  some 
4.  Absorption  cases,  which  on  the  lower  jaw  is  of  no 
of  the  Tissue        great    consequence,    as    the    teeth    do    not 

show  very  much;  but  in  the  upper  jaw,  and 
especially  in  front  of  the  mouth  the  tissue  has  to  be  replaced. 
To  avoid  ungainly  long  teeth  we  use  saddles,  replacing  gum 
as  well  as  teeth.  Gum  teeth  can  be  used,  or  the  bridge  can  be 
made  in  i)latinum,  witli  continuous  gum.  (Figures  7,  8,  9.) 
Often  the  gum  over  one  tooth  only  needs  to  be  restored; 
this  can  be  accomplished  by  baking  pink  porcelain  on  a  long 
plain  tooth.  In  cases  of  much  absorption,  the  restoration  can 
be  accomplished  more  satisfactorily  with  removable  bridges, 
especially  from  the  sanitary  point  of  view. 


Fig.  7.     Absorption  of  tissue.     Model  shows  the  absorption  of  tissue  which  has 
taken   place    on   account   of   pyorrhoeatic   conditions,   and   the   replacement   with 

a   sum  block. 


mi  A 


A  B 

Fig.  8.  Absorption  of  tissue.     Models  show  two  bridges  constructed  to  restore 

the   absorbed   tissue. 


A  B 

Fig.  9.     Absorption  of  tissue.    A  shows  the  length  of  teeth  which  would  have 
to  be  used  for  a  bridge  without  gum.     B  shows  the  gum  block  of  the  same  case. 


20 


CROWNS  AND   BRIDGES 


B.     AS  TO   OCCLUSION 

Mal-occlusion  is  a  Yerj  frequent  complication  in  crown  and 
bridge  work.  Therefore  it  is  very  important  to  study  sucli 
a  case  witli  the  aid  of  models. 

In  a  case  with  normal  occlusion  there  is, 
1.   Normal  strictly  taken,  no  tooth  missing.     However, 

Occlusion  we  will  put  under  this  head  all  the  cases 

which  need  but  restoration  of  a  certain  num- 
ber of  teeth  to  give  normal  occlusion.  These  are  among  the 
jnost  common  cases  of  crowns  or  bridges.      (Figure  10.) 


Fig.    10.     Bridge   case   with   normal   occlusion.     Upper    six-year    molar   missing. 


Sufficient  occlusion  is  a  very  convenient 
2.   Sufficient  term  for  which  we  are  indebted  to  Dr.  Eu- 

Occlusion  gene  Smith,  of  Harvard  Dental  School.    The 

occlusion  is  not  normal,  but  the  patient  finds 
it  sufficient,  because  restoration  to  normal  occlusion  would  in- 
volve changes  out  of  proportion  to  the  result,  on  account  of 
technical  difficulties. 

In  this  class  come  cases  of  edge  to  edge  bite,  of  over-bite 
of  the  lower  molars  and  bicuspids,  and  some  cases  of  mandib- 
ular, or  maxillary  protrusion.      (See  Figure  11.) 


CLASSIFICAriON 


21 


3.  Mal-occlu 
sion 


Mal-occlnsion  in  llie  adult  can  come  from 
neglect  of  treatment  for  orthodontia  in 
childhood,  or  can  be  acqnired  in  late  life  as 
'^closed  bite"  from  loss  of  teeth  or  wear;  as 
"protrnsion"  of  the  maxillary  incisors,  caused  by  pressure  from 
the  lower  ones;  or  as  "tipping"  or  "elongation"  of  teeth  on 
account  of  spaces,  etc.  We  will  subdivide  these  and  consider 
them  separately. 


Fig.    U.     Sufficient   occlusion,   edge  to  edge  bite  of   the   incisors,   and   over-bite 
of  the  lower  bicuspids  and  molars. 


Fig.  12.     Mal-occlusion.     Spaces  mesially  and  distally  of  the  upper  molar.     The 
contact    points    have    been    restored    by    a    hand-carved    porcelain    crown    with 

cast  base. 


22 


CROWNS  AND  BRIDGES 


(a)  Lack  of  contact  points.  Teeth  have  the  tendency  to 
move  forward  if  a  space  occurs  from  extraction  (see  Figure 
12),  but  the  contact  point  is  not  always  restored  entirely,  and 
the  space  left  is  frequently  a  great  source  of  trouble.  But 
spaces  between  teeth  are  not  necessarily  clirectl}'  due  to  the 
loss  of  a  tooth.  The  teeth  posterior  to  an  extracted  tooth  move 
forward,  but  the  tooth  anterior  to  the  space  often  moves  back 
on  account  of  force  from  the  occlusion  of  the  antagonist  (Fig- 
ure 13.)  Small  spaces  also  occur  from  supra-numerous 
(Figure  14)  peg-shaped  teeth,  and  from  insufficient  restoration 


1 

■ 

;^ 

Fig.    13.     Mal-occlusion.     Space  between  the  upper  cuspid  and  bicuspid, 
latter  as  well  as  the  lower  first  bicuspid,  has  been   forced  back. 


The 


of  fillings  and  decay.  Spaces  of  that  nature  ought  to  be  filled 
in,  either  by  contour  fillings,  inlays  (Figure  15)  with  special 
extensions,  crowns  with  large  contour  (Figure  16),  or  if  the 
space  is  next  to  an  abutment,  the  latter  has  to  be  constructed 
to  restore  the  contact  point. 

(b)  Teeth  tipped  forward.  (Figure  17.)  Teeth  which 
have  tipped  towards  the  space,  or  have  been  pushed  out  of 
vertical  direction  by  force  of  a  faulty  bite,  complicate  bridge- 
work  considerably.     In  some  cases  they  can  be  ground  suffi- 


Fig. 


14.     Mal-occlusion.     Space   between    the    lower   cuspid    and    first    bicuspid, 
caused  by  a  supra-numerous  tooth,  which  was  not  extracted  in  time. 


A 


B 


Fig.  15.  Mal-occlusion.  A,  space  between  the  six-year  molar  and  second 
bicuspid  caused  by  the  extraction  of  the  first  molar.  Space  between  the  second 
and  third  molar  caused  by  decay.     B   shows  the  same  case  with  all  the  contact 

points   restored. 


Fig.  16.     Mal-occlusion.       The  space  between  the  lower  twelve-year  molar  and 
the   second  bicuspid   was   filled   with   gold   crowns,   sufficiently   built   out   to   get 

the  contact  point. 


24 


CROWNS  AND   BRIDGES 


Fig.    17.     Mal-occlusion.     The    molar    is    tipped    forward,    so    as    to    render   the 
making   of   an   ordinary    bridge    impossible. 

cientlj  to  bring  them  in  line,  but  in  extreme  cases  it  is  most 
always  necessary  to  use  special  constructions,  as: 

1.  TAVO-piece  bridges   with   interlocking   device.      (See 

Figure  18. ) 

2.  Inlays  with  post  for  abutments.     ( See  Figure  19. ) 

3.  Kemovable  bridges. 


Fig.   18.     Mal-occlusion.     Bridge  with  interlocking  device  to   overcome  the  tip- 
ping of  the  tooth.     For  construction  see  Fig.   170. 


(c)  Teeth  elongated.  Teeth  wliich  do  not  occlude,  usually 
elongate,  that  is,  they  grow  down  from  the  maxilla,  or  up  from 
the  mandible.  (Figure  20.)  These  have  to  be  restored  to 
normal  length,  either  for  looks  or  to  get  proper  masticating 


CLASSIFICAriON 


Fig.    19.     Mal-occlusion.     Bridge  with   inlay  abutments, — one   way   to   overcome 
the   difficulty   of   tipping   teeth. 

occlusion,  if  the  space  opposite  is  bridged.  AVlien  tliey  are 
ground  down,  and  if  the  contact  points  are  not  lost,  tliev  can 
be  filled  with  a  well-carved  inlay  to  replace  the  occlnsial  sur- 
face. If  the  contact  points  are  lost,  as  in  teeth  with  narrow 
necks,  it  is  best  to  crown  the  tooth  with  a  suitable  crown,  or 
to  cut  a  mesial-occlusial-distal  cavitv  for  an  extension  inkiT. 


Fig.  20.     Mal-occlu.sion.     The  upper  bicuspid  has   elongated  on  account  of  the 
loss    of   the   lower    teeth.     The    bite    has    closed,    making    the    condition    worse. 


26 


CROWNS  AND   BRIDGES 


(d)  Temporary  teeth  retained.  Very  often  we  find  re- 
tained temporary  teeth  in  persons  of  advanced  age,  and  the 
question  arises  whether  they  should  be  used  as  abutments.  A 
radiograph  will  give  the  desired  information.      (Figure  21.) 


Fig.  21.     The  right  lateral  incisor  is  a  temporary  tooth.     The  X-ray  shows  that 

the   root  is   perfectly   healthy,    and    strong   for   an   abutment.     The   X-ray   also 

ascertains   the   absence   of   a   permanent   lateral    incisor. 

If  the  root  is  strong,  firm  and  no  absorption  at  the  apex,  there 
is  no  reason  why  it  should  not  be  a  good  abutment.  But  if 
we  find  the  tooth  i)artly  absorbed   (Figure  22),  or  if  there  is 


Fig.  22.     Radiograph  showing  absorption  of  the  roots  of  two  temporary  teeth, 
the   central   and   lateral   incisors.     The   cuspid  has    a   strong,   healthy   root   with 
no  absorption.     Be   careful  not  to   attempt  to   crown   a   tooth,   when   you    en- 
counter a  large  opening  and  bleeding  in  the  root  canal. 

an  impacted  permanent  tooth  (Figure  23),  these  conditions 
should  be  carefully  considered.  A  temporary  root  on  which 
absorption  has  started  is  hopeless.     If  the  corresponding  per- 


CLASSIFICATION 


27 


A  B 

Fig.  23.     Showing  unerupted  cuspids  under  bridges,  illustrating  the  importance 

of  radiographic  examination  before  constructing  bridges. 

manent  tooth  is  impacted  and  ill-placed  wliile  the  temporary 
root  stays,  and  no  sign  of  absorption  is  shown  in  the  radio- 
graph, we  may  remove  the  permanent  tooth  and  use  the  tem- 
porary root.  If  there  is  a  good  chance  for  the  permanent  tooth 
to  come  down  in  good  line,  we  may  hasten  its  coming  to  the 
snrface  by  extracting  the  temporary  root  and  making  s[>ace 
for  the  permanent  tooth  by  cntting  away  overhanging  bone 
and  keeping  the  space  open. 

(e)   Closed  bite.     The  bite  may  be  closed  from  the  loss  of 
the  back  teeth,  and  the  wearing  down  of  the  front  teeth.     The 


A  B 

Fig.  24.  Mal-occlusion  closed  bite.  The  bite  has  closed  to  such  an  extent, 
the  upper  incisors  have  worn  down  so  much,  that  the  pulps  were  visible  on 
the  palatal   side.     A  Ijefore,   B   after  repairing  the   incisors   with  inlays   and  the 

sides  with  bridges. 


CROWNS  AND   BRIDGES 


upper  incisors  are  worn  on  the  cutting  edge,  or  on  tlie  palatal 
surface  (Figure  24),  or  are  pushed  out.  If  abrasion  is  the 
cause,  the  remedy  consists  in  elongating  the  molars  and  bicus- 
pids with  so-called  shoes  or  with  bridgework  (Figures  24,  25,  26, 


A  B 

Fig.  25.     Mal-occlusion  closed  bite,  the  lower  jaw.     A  before,  B  after  treatment, 

filling  the   spaces  with  bridgework. 

27  and  28).     In  some  cases  filling  of  the  incisors  at  the  palatal 
surface  or  gold  inlays  containing  iridio-platinum  is  sufficient. 

However,  loss  of  teeth  and  cavities  more  frequently  produce 
this  condition.  The  bite  can  be  opened  with  bridgework  or 
a  plate. 


Fig.   26.     Mal-occlusion,    closed   bite.     Front  view,   before   and   after   treatment. 


CLASSIFICATION 


29 


(f)  Maxillary  and  mandibular  protrusion.  (Figures  29  and 
30.)  It  is  often  desirable  not  only  to  adjust  occlusion  to  im- 
prove mastication,  but  moreover  to  restore  beauty  and  har- 
mony of  the  face.  If  after  a  certain  age  orthodontia  has  ceased 
to  be  applicable,  cases  of  protrusion  with  irregularities  of  the 
front  teeth  can  be  corrected  by  bridgework  in  a  more  radical 
manner.     The  irregular   teeth   can   be   cut  off  and   porcelain 


Fig.   27.     Mal-occlusion,   closed  bite.     These   views   of   the   left   side   show   con- 
ditions  before   and   after   restoration,   with   bridgework   to   open   the  bite. 


Fig.  28.     Mal-occlusion,  closed  bite.     The  right  side  of  the  same  case  (Figs. 
24-28),  same   mouth,   before   and   after   treatment. 


30 


CROWNS  AND   BRIDGES 


crowns  fitted  at  a  different  angle.  In  Figure  31  four  teeth 
were  replaced  by  a  bridge  of  three  teeth  to  get  a  better  appear- 
ance and  occlusion. 

(g)   Wandering  teeth.    With  this  term  we  mean  teeth  which 
have  been  forced  out  of  line  either  singly,  or  in  groups,  by  mai- 


FiG  29  Mal-occlusion.  The  incisors  have  been  pushed  out  on  account  of  the 
closing  bite.  Models  show  the  loss  of  the  teeth  in  the  upper  and  lower  jaw, 
causing   this    condition.        (See    construction    of   bridges    for    this    case.     Figs. 

202-211.) 

occlusion,  and  it  is  characteristic  that  they  keep  getting  worse, 
moving  further  and  further,  pressed  usually  by  a  closing  bite. 
(Figure  32.) 


Fig.   30.     Mal-occlusion,   mandibular   protrusion.     Harvard  Dental   School  case.     Before  and 
after  treatment  in  the  Orthodontia  and  Crown  and  Bridge  Departments. 


32 


CROWNS  AND  BRIDGES 


In  these  cases  single  crowns  are  contra-indicated ;  sncli  teeth 
have  to  be  connected.  Usually  the  roots  have  taken  an  oblique 
direction,  and  have  to  be  cut  flush  with  the  gum;  a  bridge  is 
then  constructed  with  crowns  extending  down  vertically,  or  the 
trouble  is  overcome  by  a  removable  bridge.      (Figure  33.) 


Fig.  31. 


Mal-occlusion,  maxillary  protrusion, 
after  treatment. 


B 


Model  A,  before;  model  B, 


A 

Fig.  32.     Mal-occlusion,  the  upper  incisors  are  projecting, 
before;   B,  after  treatment. 


B 

A   shows  condition 


CLASSIFICATION 


32, 


Fig.  2,Z.  Mal-occlusion,  wandering  teeth.  A  shows  case  before  treatment;  the 
teeth  have  the  tendency  to  move  and  are  extending  in  all  directions.  B  shows 
teeth  cut  off  at  the  gingival  margin,  and  connected  with  a  wire,  which  holds 
them  together,  and  also  serves  as  abutment  for  a  removable  bridge.  (  See  con- 
struction Fig.  219-221.) 

Often  it  occurs  that  tlie  maxilla  seems  to  separate,  produc- 
ing a  space  between  the  central  incisors,  especially  if  we  have 
l)ridges  on  either  side  involving  the  centrals  on  each  side. 
Cases  of  that  sort  can  be  drawn  together  and  fixed  with  a 
staple,  or  a  vault  bar  to  tlie  bridge.  If  spreading  is  prognoswl, 
in  mouths  with  otherwise  normal  conditions,  this  can  be  cor- 
rected by  inserting  a  staple.      (I'igure  34.) 

(h)  Irregularly  arranged  teeth.  Regulating  irregularities 
for  sake  of  appearance  is  a  task  the  bridge  specialist  is  often 


^^^  ^^^H 


Fig.   34.     Mal-occliision.     Spreading   of  the   two   central    incisors.     Case   treated 

fifteen  years   ago.     Radiograph   showing   condition   today   with   perfectly   normal 

pnlps.     The    holes    for    the    platintim    staple    wire    were    drilled    between    vhe 

enamel  wall  and   pulp   chamber. 


Fig.  35.     Mal-occlusion.     A  shows  the  position  of  the  upper  lateral,  and  cuspid. 

The  lateral  protrudes,   the  cuspid  occludes   lingually,   and   is   twisted.     B   shows 

two  Davis  crowns  in  good  occlusion,  which  have  been  attached  to  the  roots. 


Fig.  36.  Mal-occlusion.  The  one  lateral  incisor  is  absent,  the  front  teeth  are 
of  irregular  length,  and  have  the  tendency  to  move  upward,  on  account  of 
pyorrhoeatic  condition.  Fig.  9A  shows  four  teeth  which  would  fill  the  space 
for  this  case,  which  occurred  after  the  absorption  of  the  process.  Fig.  9B  is 
a  gum  block  carved  for  this  case.  Fig.  8B  shows  the  finished  bridge  with 
half-crowns    and   posts   for   abutments. 


f!f^^^^^H^^^^^^^^^^H^|B 

A  B 

Fig.    "ill .     Mal-occlusion.   .  The   case    with  very   irregular   teeth   as    shown   in   A, 

replaced  by  a  bridge.     In   Figure  B  the   same   result  might  have  been  obtained 

with  porcelain  crowns,  but  the  case  was  a  pyorrhoeatic  one,  and  two  teeth  had 

to  be  extracted,  and  the  further  moving  of  the  teeth  prevented  by  a  bridge. 


36  CROWNS  AND   BRIDGES 

confronted  with.  As  a  rule  the  teeth  in  question  are  the  in- 
cisors and  cuspids.  The  crowns  of  twisted,  protruding  or  re- 
truding  teeth  can  be  replaced  by  porcelain  crowns  with  normal 
and  artistic  appearance.  (Figure  35).  If  the  whole  set  of 
incisors  has  to  be  changed,  we  have  a  more  difficult  problem. 
As  a  rule  there  is  lack  of  space  for  four  incisors  lined  up  in 
normal  position,  and  it  is  hard  to  decide  whether  tliree  incisors 
give  a  more  artistic  appearance  than  four  very  narrow  ones. 
Each  case  is  a  study  in  itself  and  must  be  left  to  the  good  judg- 
ment of  the  operator.      ( See  practical  cases  Figures  36  and  37.  > 


IV.  PRELIMINARY  TREAT- 
MENT OF  THE  MOUTH 
AND  TEETH 

Before  starting  with  bridgework  the  mouth  should  be  put 
in  general  good  condition.  Sources  of  infection  should  be 
eliminated. 

First  of  all  the  teeth  should  be  scaled  and 

1.  Prophylactic  cleaned  and  polished,  which  also  gives  ns  an 
Treatment  opportunity    to    select    the    right    shade    of 

the  teeth. 

The  next  thing  is  to  extract  all  roots  and 

2.  Exodontia       teeth  which  have  been  decided  upon  as  worth- 

less. 

If  there  are  pj^orrhoeatic  teeth,  these  should 

3.  Pyorrhoea  be  treated;  scaling  and  in  some  cases  devital- 
Treatment  izing  is  indicated.     If  they  are  to  serve  as 

abutments,  they  should  be  cut  down  at  once 
to  receive  surgical  rest.  If  all  or  most  of  the  teeth  are  affected, 
a  temporary  splint  might  be  applied  until  the  treatment  has 
sufficiently  progressed.  In  some  cases  temporary  plates  are 
advisable  to  relieve  the  strain  from  the  affected  teeth. 

It  is  a  much  discussed  question  among  crown 

4.  Devitaliza-  and  bridge  workers,  whether  a  tooth  should 
tion  of  Healthy  be  devitalized  previous  to  crowning  in  all 
Teeth  cases.     There  are   well-known   writers   who 

advocate  devitalization  in  every  case  for 
various  reasons.  And  there  are  also  a  great  many  other  prac- 
titioners who  can  prove  that  pulps  do  live  under  crowns 
(see  Figure  38),  and  think  that  it  is  not  justifiable  to 
remove  a  healthy  pulp  and  take  the  chance  of  not  even  being 
able  to  thoroughly  fill  the  root  canals.     Therefore  the  author 


38 


CROWNS   AND   BRIDGES 


leaves  it  to  the  operator  to  choose  the  wisest  course  and  be  gov- 
erned by  the  condition  he  is  working  under,  and  not  by  any 
law  of  one  method  only. 


Fig.  38.  Radiographs  showing  cases  where  teeth  have  been  crowned  without 
devitalizing  the  pulps.  The  lower  radiograph  shows  a  right  and  left  lower,  one 
tooth  extension  bridge,  both  bridges  in  same  mouth.  The  upper  are  bridges 
with  live  pulps  in  healthy  condition,  after  fifteen  years.  Left  lower  radiograph 
shows  a  gold  crown  over  tooth  with  live  pulp,  after  twelve  years.  Right  lower, 
gold  crowns  of  teeth  with  live  pulps  after  twenty-three  years. 


The  pulps  of  all  the  teeth  involved  in  crown 
and  bridge  work  sliould  be  examined  as  to 
their  vitality.  All  the  teeth  with  patholog- 
ical pulps  as  well  as  devitalized  teeth  should 
be  examined  with  the  aid  of  radiographs. 
These  should  be  carefully  studied,  and  usu- 
ally we  can  determine  whether  the  tooth  can  be  treated  from 
the  root  canals,  or  whether  surgical  treatment  is  indicated. 


5.  Treatment 
of  Teeth  with 
Pathological 
Pulps 


(a)   Treatment  from  root   canals.  Gases    of    pulpitis, 

acute  alveolar  abscesses,  and  sometimes  chronic  abscesses  can 
be  treated  from  the  pulp  chamber.  The  complete  opening  of 
the  root  canals  is  the  most  difficult  part  of  this  operation,  and 


PllELIMINA  R  Y    TRE/J  TMENT 


39 


Cailiu'cs  ill  tliis,  as  well  u.s  in  the  proper  tilling  of  tli«'  canals, 
i^ive  rise  to  the  most  coiHleinnable  conditions.  There  is  mucli 
more  troiil)h.'  cominn  from  insufficient  root  treatment  tlian 
from  the  percenta<ie  of  normal  pnlps  dvinj*-  nnd(n-  crowns. 
Chronic  alveolar  abscesses  derived  froin  improperly  treated 
roots  are  today  the  comnioncsf  soni-cc  of  most  serious  trouble. 
(Figures  39  and  40.) 


Fig.   39.     Radiographs    showing  chronic   abscesses   on   the   roots   of   upper  teeth, 
which  have  been   used  as  abutments,  the   root  canals   not  having  been   properlv 

filled. 


Fig.  40.     Radiographs   showing   chronic  abscesses   on   the   roots   of  lower   teeth, 

whicli    Iia\'c    been   used    as   abutments    for  bridgework,    and   the   root    canals   of 

which    iia\'e   not   been   properly    treated    and   filled. 


40 


CROWNS   AND   BRIDGES 


It  is  of  the  greatest  importance  that  teeth  used  for  bridge 
abutments  should  be  treated  with  the  utmost  care,  and  it  is 
next  to  malpractice  to  neglect  intentionally  the  application  of 
any  means  which  modern  science  makes  available  to  reach  the 
very  best  results.  Large  numbers  of  radiographs  are  some- 
times necessary  to  open  root  canals,  a  process  which  requires 
patience  and  time  more  than  anything  else.  (Figure  41.) 
After  sterilizing  the  inside  of  the  tooth  with  one  of  the  well- 
known  methods,  we  come  to  the  filling,  and  the  careful  filling 


Fig.  41.     Series  of  radiographs  showing  treatment  and  filHng  of  root  canals  of 
teeth   to  be  used   as  bridge  abutments. 

of  root  canals,  is  of  equal  importance  as  the  opening  up.  It 
is  evident  that  the  better  a  canal  is  opened  the  easier  it  is  to 
fill  it.  A  proper  root  filling  should  extend  through  the  apical 
foramen,  and  should  be  so  condensed  that  it  fits  its  outline 
closely.  This  also  should  be  ascertained  with  the  radiograph. 
The  pain  caused  when  the  root  canal  cone  is  pushed  through 
the  foramen  is  not  a  safe  guide  for  root  canal  fillings.  If  a 
canal  is  not  properly  cleaned,  there  is  sometimes  similar  sen- 
sation produced,  when  the  point  passes  in  the  apical  part  of 
the  root.     Figure  42  shows  such  a  case.     The  operator  in  this 


PliELIMINAk  Y    TREA  TMENT 


41 


case  was  very  careful,  and  intended  to  do  liis  very  best  to  fill 
the  canal  properly.  The  patient  felt  the  root  canal  filling 
penetrating-  through  the  apex,  and  saw  the  results  in  the  radio- 
graph taken  five  years  later. 


Fig.  42.  Radiograph  of  second  bicuspid  and  first  molar  with  chronic  abscesses, 
cyst  in  the  latter.  When  the  root  canal  of  the  second  bicuspid  was  filled,  the 
patient  felt  the  gutta-percha  point  penetrate  through  the  apex.  See  the  result 
to  show  that  the   sense  of  pain,  produced  by  the   gutta-percha  point,   is   not  a 

sure   guide. 

Chronic  alveolar  abscesses  are  not  so  easily  treated.  Ex- 
ostosis, granulnni,  or  cyst  frequently  complicate  cases  of  long 
standing.  Medical  treatments  from  the  root  canal  do  not  al- 
ways give  satisfactory  results  on  account  of  bent  roots,  calcified 
canals,   open   foramina   in  young  teeth,   and   branching  root 


Fig.  43.     Showing  bent  root  of  a  lower  second  bicuspid. 


canals.  Figure  43  shows  a  radiograph  of  a  badly  bent  root, 
which  could  not  be  properly  filled.  Figure  45  and  Figure  46 
show  radiographs  of  teeth  with  calcified  pulps,  normal  pulps, 


42 


CROWNS   AND   BRIDGES 


open  apices,  and  abnormal  branching  of  the  root  canal.  Zinc 
electrolysis  is  the  best  treatment  for  alveolar  abscesses  known 
at  the  present  date,  and  should  be  the  routine  treatment  of 
all  these  cases.  If  there  are  complications  there  is  usually, 
however,  only  surgical  treatment  left  to  be  resorted  to. 

(b)   Treatment   from   alveolar  side   surgically.        In   cases 
where  chronic  abscesses  do  not  3'ield  to  treatment,  in  cases  of 


Fig.    44.     Radiographs    of    receded   pulps,    and    constricted    chambers,    as    found 

in  advanced  age. 


M 


Fig.   45.     Radiographs   showing   large   pulp   chambers,   such   as    found   in   young 

teeth. 


n 


Fig.  46.     Radiographs   showing  abnormal   branching  of  root   canals. 

complications  on  the  outside  of  the  root,  a  radical  operation  is 
necessary.  Either  the  tooth  has  to  be  extracted  and  the  socket 
curetted,  or  if  practical,  the  apex  of  the  root  which,  in  sucli 
cases  is  always  gangrenous,  should  be  amputated.  This  can 
be  performed  on  almost  all  teeth  ;  the  single-rooted  ones,  how- 


PRELIMINARY    TREATMENT  43 


ever,  are  the  easier.  In  aiiipntating  the  biu.eal  root  of  the 
upper  bicuspids,  A\e  must  take  care  not  to  injure  tlie  antrum, 
and  in  the  lower  bicuspids,  the  mental  nerve.  The  two  last 
mandibular  molars  are  the  liardest  ones  on  account  of  Hieir 
position. 

6.     BUILDING   UP   OF   DECAYED  AND  BROKEN- 
DOWN  TEETH 

If  the  teeth  which  serve  as  abutments  are  decayed,  this  de- 
cay should  be  carefully  removed,  and  the  cavity  filled  with 
suitable  material,  as  cement  and  amalgam.  Should  the  decay, 
however,  have  progressed  to  such  an  extent  as  to  render  tlie 
tooth  frail,  or  should  the  crown  be  broken  down  entirely,  it 
can  be  built  up  in  the  following  manner : 

1.  After  removing  all  decay  and  treating  and  filling  the 
root  canals,  fit  post  of  sufficient  length  into  same.  The  best 
posts  are  those  with  a  thread,  they  hold  better  in  the  canals, 
and  give  better  attachment  to  the  amalgam. 

2.  Cement  the  posts  into  the  canals. 

3.  Select  a  seamless  band  of  copper,  or  other  suitable  metal, 
and  fit  it  over  the  root  and  trim  to  allow  closing  of  the  teeth  and 
sufficient  space  for  the  top  of  the  crown. 

4.  Sterilize  and  dry  the  tooth,  and  fill  the  band  with  amal- 
gam. The  patient  is  discharged,  and  the  band  removed  at  a 
later  sitting.  This  gives  a  good  abutment  for  an  all-metal 
crown. 


V.    ORAL  ANAESTHESIA 

In  crown  and  bridge  work  we  perform  tlie  most  radical 
dental  operations,  operations  which  under  certain  conditions 
would  be  almost  impossible  to  perform  without  an  anaesthetic. 
To  devitalize  a  tooth  without  cavity  or  to  prepare  a  tooth  for 
a  crown,  in  a  frightened  patient,  with  very  sensitive  teeth,  is 
sometimes,  to  say  the  least,  a  very  tedious  task.  The  grinding 
is  frequently,  on  account  of  the  patient's  attitude,  not  per- 
formed completely,  resulting  in  an  ill-fitting  crown.  There  are 
more  failures  in  bridge  work,  resulting  from  not  being  radical 
enough  than  from  any  other  cause;  and  the  reason  wh}^  the 
work  is  done  in  too  conservative  a  manner  is  in  most  cases  due 
to  pain,  on  account  of  the  unwillingness  of  the  patient  to  per- 
mit these  most  necessary  operations. 

The  importance  to  relieve  pain  then  is  two-fold :  it  decreases 
the  strain  on  the  patient  and  it  gives  the  dentist  a  chance  to 
perform  his  work  more  thoroughl3\ 

There  is  no  doubt  that  local  anaesthesia  has  proved 
its  superiority  over  general  anaesthesia  for  our  w^ork.  Local 
anaesthesia  gives  us  plenty  of  time;  there  is  nothing  to  ab- 
stract our  attention,  we  have  the  cooperation  of  the  patient, 
and  can  therefore  concentrate  our  mind  on  one  thing :  perfect 
work. 

Local  anaesthesia  is  based  upon  thorough  knowledge  of  the 
oral  anatomy,  exact  technique,  and  scrupulous  asepsis.  Refer- 
ring for  detail  information  to  Thoma's  book  on  "Oral  Anaes- 
thesia," this  chapter  will  describe  only  the  instrumentarium, 
drugs  and  technique,  as  specially  applied  to  crown  and  bridge 
work. 

A.    INSTRUMENTARIUM 

1.  Use  two  Fischer  syringes,  one  mounted  in  a  short  hub 
with  a  26  mm.,  the  other  in  a  long  hub  with  a  45  mm.,  iridio- 
platinum  needle.  I  prefer  iridio-platinum  needles  because  they 
simplify  matters,  in  that  they  do  not  need  to  be  boiled  before 


Fig.  48.  Syringes.  The  small  syringes  with  27-gauge  platinum  needle  for 
mucous  anaesthesia,  previous  to  injecting  with  the  large  syringe.  The  next 
syringe  is  Fischer's  syringe  mounted  with  the  short  needle.  The  third  is 
mounted  with  the  45  mm.  long  needle,  and  the  last  one  is  mounted  with  the 
bayonet  piece  and  a  60  mm.   long  needle. 


Fig.  49.     Large  and  small  dissolving  cups. 


01L4L   ANAESTHESIA  47 


use,  can  be  used  uj;jnn,  jiiid  I  lici-c^lorc  <-;ni  always  be  mounted 
on  the  syringe  ready  for  use.  They  do  not  break.  If  steel 
needles,  wliieli  often  show  specks  of  rust  and  oxide,  are  used, 
one  lias  to  boil  llieni  and  sliould  only  use  them  once. 

2.  One  glass  jar,  filled  with  absolute  alcohol,  containing 
nickel-plated  stand  for  syringes  and  porcelain  cups. 

3.  One  bottle,  double  corked,  for  pliysiological  salt  solution. 

4.  One  small  porcelain  dissolving  cup,  graduated  from 
1  to  3  cc,  and, 

5.  One  large  cup  graduated  up  to  10  cc.  These  are  used 
to  measure  and  cook  the  solutions,  to  dissolve  the  tablets  and 
fill  the  syringe. 

6.  One  glass  tray,  with  cover,  to  keep  tablets  and  reserve 
needles. 

7.  Alcohol  lamp. 

B.  DRUGS 
Physiological  salt  solution.  Instead  of  using  normal  salt 
solution  to  dissolve  the  Novocain  tablets,  I  use  and  recommend 
a  solution  containing  also  calcium  chloride  and  potassium 
chloride.  This  is  called  Ringer  solution,  made  from  Ringer 
tablets.*     They  contain : 

Sodium  chloride 0.050  gram 

Calcium  chloride 0.004      " 

Potassium  chloride 0.002       " 

Dissolve  10  tablets  in  100  cc.  of  pure  distilled  water,  and 
sterilize. 

NOVOCAIN   L  =  SUPRARENIN   SYNTHETIC 

E  Tablets*  containing  Novocain     ....      0.02  gram. 

L-suprarenin  synthetic    0.000,05       " 
F  Tablets*  containing   Novocain     ....     0.05  " 

C.    PREPARING  OF  THE  SOLUTION 

Remove  the  stand  from  the  jar,  and  wash  the  cup  and 
syringe  in  distilled  water,  to  remove  all  traces  of  alcohol. 
Then  fill  the  cup  with  Ringer  solution  to  the  mark  and  boil 

*  Farbwerke   Hoech.st    Co.,    Ill    Hudson   St.,    New  York. 


48  CROWNS  AND  BRIDGES 

this  solution  over  the  flame  for  a  few  seconds.  Add  the  tab- 
lets, as  required,  and  draw  it  through  the  flame  till  they  are 
dissolved.  The  syringe  then  is  filled  from  the  cup  and  the 
needle  sterilized  in  the  flame.     Use  the  following  solution : 

In  normal  cases  of  extirpating  pulps,  prepar- 

1.  For  All  ing  teeth  to  receive  crowns  or  for  extraction 
Normal  Gases     the  bleeding  should  be  only  little  decreased. 

It  is  therefore  important  to  use  but  a  small 
amount  of  suprarenin.  This  does  not  shorten  the  time  of  an- 
aesthesia, as  experience  has  proven.     Use: 

1  E  tablet  ^ 

plus         y  to  3.5  c.c.  of  Einger  solution.     This  gives 

1  F  tablet  ] 

Novocain 2% 

Suprarenin    ....   0.000,015  gram  to  1  c.c. 

For  deep  anaemia  as  required  in  cases  of  dif- 

2.  For  Deep  ferent  extraction,  or  amputation  of  the  apex 
Anaemia  of  a  root,  use:  1  E  tablet  to  each  1  c.c.  of 

Ringer  solution.     This  gives  : 

Novocain 2% 

Suprarenin    ....      0.000,05  gram  to  1  c.c. 

3.  For  Abnor-  For  abnormal  cases,  arteriosclerosis,  cardiac 
mal  Cases  disorders,  hysteria,  it  is  advisable  to  decrease 

the  amount  of  suprarenin  used : 

1  E  tablet    )   ^    rr         -r,.  t    .- 

2  F  tablets  ]  *°  ^  '■'■  ^'"S"''  '°'"*'°"- 

gives 

Novocain 2% 

Suprarenin 0.000,009  to  1  c.c. 

However,  I  want  to  call  attention  to  the  fact  that  the 
second  and  third  solutions  are  very  seldom  used,  and  that  there- 
fore the  preparation  of  the  solution  is  much  simpler  than  it 
appears. 

The  tablets  are  sterile,  in  tubes  of  twenty.  Always  replace 
the  rubber  stopper  at  once,  otherwise  the  drugs  will  be  de- 
teriorated from  the  influence  of  air,  light  and  moisture. 


ORAl.    AN/IESrilESIA  49 

REQUIREMENTS  OF  A  SOLUTION   PREPARED 
FROM   TABLETS 

1.  It  should  be  immediately  used  after  it  lias  Ijeeii  \)Vi'.- 
pared. 

2.  The  solution  should  not  come  in  contact  witli  anvthinj;-, 
except  the  porcelain  cup  and  the  syringe. 

It  should  not  be  left  longer  than  absolutely  necessary  in 
the  dissolving  cup  nor  in  the  syringe.  The  solution  is  very 
sensitive,  being  affected  and  chemically  changed  b}'  air,  heat, 
light,  and  especially  alkalies. 

3.  The  tablets  should  not  be  touched  with  hands  nor  in- 
struments and  the  tube  should  be  closed  immediately  after  use 
with  the  rubber  stopper.  The  tablets  are  chemically  clianged 
by  air,  light  and  especially  moisture. 

4.  The  tablets  should  be  white;  sometimes  the  uppermost 
one  discolors  from  chemical  clianges  caused  by  improper  hand- 
ling of  the  tube. 

5.  The  solution  gained  from  the  tablets  should  be  clear 
as  water. 

If  it  shows  any  light  i)ink  color,  it  sliould  be  discarded. 

D.     PREPARING  OF   PLAGE  FOR  INSERTION   OF 
THE  NEEDLE 

An  unclean  mouth  should  first  be  sprayed  out  with  an  anti- 
septic solution,  then  hold  the  lip  away  from  the  gum,  and  with 
a  short  roll  wipe  all  the  mucus  from  the  field  of  operation. 
Then  with  a  little  bit  of  cotton  dipped  in  campho-phenique,  or 
tincture  of  iodine,  equal  parts,  sterilize  and  anaesthetize  the 
part  where  the  needle  is  to  be  inserted.  In  very  sensitive  pa- 
tients I  use  a  small  hypodermic  syringe,  with  a  very  fine  and 
sharp  platinum  needle  and  inject  a  few  drops  of  novocain  solu- 
tion previous  to  the  injection. 

E.    INFILTRATION  METHOD 

This  method  depends  upon  diffusion  of  the  solution  through 
the  pores  of  the  bone,  thus  reaching  the  dental  nerve  before 
it  enters  the  tooth.  The  number  of  pores  is  different  over  dif- 
ferent teeth,  and  in  the  upper  jaw  different  from  the  lower. 
(Figure  50.)      Moreover,  the  density  of  the  bone  varies  greatly 


Fig.    so.     Skulls    showing    the    small    foramina    in    the    alveolar   process    of    the 
maxilla,  and  in  the  incisor  region  of  the  mandible. 


ORAL   ANAESTHESIA 


51 


in  different  individuals.  Without  exception  this  method  can 
be  used  for  any  teeth  in  the  upper  jaw.  Tlie  lower  jaw  is 
porous  only  in  the  mental  fossa,  while  in  the  region  of  the  back 
teeth  the  bone  is  very  dense.  The  infiltration  method,  there- 
fore, is  not  advisable  for  the  lower  jaw,  except  for  the  four 
incisors. 


Fig.   51.     Position   of  the  operator  when   injecting   for   an   upper   tooth,   by  the 

infiltration    method. 


The  point  of  insertion  on  the  labial  and  buc- 
cal side,  is  halfway  between  the  gum  margin 
and  apex  of  the  root.  The  needle  is  pushed, 
opening  directed  toward  the  bone,  down  to 
the  periosteum.  Where  a  drop  or  tAvo  is 
injected,  and  after  this  has  taken  effect,  push 
the  needle  slowly  and  carefully  upwards,  if 
necessary,  injecting  as  you  go  along,  till  you  are  opposite  the 
apex  of  the  root.  Here  I  inject  slowly  and  evenly,  moving 
the  syringe  slightly  back  and  forth,  to  avoid  injecting  into 
a  small  vein.  In  this  manner  a  depot  of  1  to  1.5  c.c.  is  depos- 
ited in  the  submucous  tissue  between  mucous  membrance  and 


1.  Injection  in 
Buccal  and 
Labial  Side  of 
Maxillary 
Teeth 


52 


CROWNS  AND   BRIDGES 


bone.  Little  force  is  needed  to  inject.  After  five  to  eight 
minutes,  anaesthesia  occurs  in  the  tooth  injected  for,  sufficient 
to  extirpate  the  pulp  without  pain. 


Fig.  52.     Radiograph  showing  the  infiltration  method   for   an   upper  cuspid. 

Here   the   procedure   is   very   much   like   in 

2.  Injection  on  the  maxilla,  often,  however,  it  is  easier  to 
Labial  Side  of  insert  the  needle  over  the  tooth  next  to 
Lower  Incisors  the  one   we  wish   to   anaesthetize,   pushing 

it  obliquel}^  toward  the  apex  of  the 
tooth  in  question. 

The  palatal  gum  of  the  maxilla  is  supplied 

3.  Injection  on  by  the  anterior  naso-palatine  nerves,  there- 
Palatal  and  fore  for  surgical  operation,  an  additional  in- 
Lingual  Sides       jection  to   produce  anaesthesia  of  the  soft 

parts  is  required.  The  same  is  true  for  the 
lingual  gum,  in  the  mandible,  which  is  supplied  by  the  lingual 
nerve.  For  these  injections  we  start  at  the  gingival  margin, 
push  the  needle  down  parallel  with  the  process,   and  inject 


(JRJL    ANAESTHESIA 


53 


0.25  c.c.  again  into  the  part  wliioli  takes  up  the  solution  the 
easiest:  the  submneons  tissue. 

The  anaesthesia  lasts  more  tlian  one  hour,  and  the  injection 
can  be  repeated,  if  necessary.  Massage  of  the  injected  area 
quickens  the  result. 


Fig.  53.  Horizontal  section  through  human  head  in  the  plane  in  which  mandib- 
ular conductive  anaesthesia  is  best  accomplished,  a.  Glandula  parotis;  b.  Ra- 
mus mandibulae ;  c.  Fascia  parotideomasseterica ;  d.  Nervus  alveolaris  inf. ;  e.  A. 
and  V.  alveolaris  inf.;  f.  Spatium  pterygomandibulare ;  g.  M.  masseter;  h.  M. 
pterygoid  int.;  i.  Nervus  lingualis ;  k.  M.  buccinator;  1.  Glandulae  palatinae ; 
m.  Art.  maxillaris  externa ;  n.  Glandulae  buccalis ;  o.  Gingiva ;  p.  Labium 
inferius;  q.  Lingua;  r.  Glandulae  buccalis;  s.  M.  masseter;  t.  M.  Diagastricus; 
u.  Art.  carotis  externa;  v.  Vena  jugularis  interna;  w.  N.  vagus,  glossopharyn- 
geus  and  hypoglossus ;  x.  Art.  carotis  interna;     y.  Ganglion  cervicale  superior; 

z.  M.   longus  capitis. 

A.     M.   rectus  capitis   anterior;    B.   Epistropheus;    C.    M.    constrictor  pharyngis 

superior ;  D.  Fascia  praevertebralis ;  E.  M.  stylopharyngeus ;  F.  M.  styloglossus ; 

G.   Tonsilla   palatina ;    H.    M.    stylohyoideus. 


54  CROWNS  AND   BRIDGES 


F.    CONDUCTIVE  METHOD 

To  anaesthetize  the  molars  and  bicuspids  in  the  mandible, 
and  if  the  infiltration  method  is  contra-indicated,  on  account  of 
septic  conditions,  we  resort  to  the  conductive  anaesthesia. 
For  surgical  operations,  we  often  use  both  combined,  to  get 
extensive  anaesthesia  combined  with  anaemia. 

In  this  method  the  conductivity  of  the  main  trunk  of  the 
nerve  supplying  the  teeth  and  tissues  in  the  oral  cavity  is 
intercepted  or  blocked  at  a  convenient  point,  while  in  mucous 
anaesthesia,  the  drug  acts  on  the  peripheral  nerves. 

Palpate  the  post-molar  triangle  with  tip  of 
1.   Pterygo-  index  finger  on  the  left,  with  the  tip  of  the 

Mandibular  thumb  on  the  right  side;  with  the  other  fin- 

Injection  ger  fixing  the  jaw.     Prepare  place  of  inser- 

tion as  described  above,  place  syringe 
(mounted  with  45  mm.  needle)  between  cuspid  and  first  bi- 
cuspid of  opposite  side,  and  insert  it  in  the  mucous  membrance 
1  cm.  over  the  last  molar,  and  try  to  feel  with  the  needle  the 
internal  oblique  line.  Then  slide  it  a  little  more  medially,  and 
push  it  forward,  keeping  in  close  contact  with  the  ramus. 
This  may  necessitate  a  different  direction  of  the  syringe  ac- 
cording to  the  angle  of  the  ramus  to  the  median  line,  which 
varies. 

After  the  insertion  of  the  needle  inject  a  small  quantity. 
Now  comes  the  distinction  in  dental  and  surgical  anaesthesia. 
The  lingual  nerve  lies  anterior  and  medially  of  the  alveolar 
nerve,  one  third  to  halfway  between  the  alveolar  nerve  and  the 
mucous  membrane.  Therefore,  by  depositing  one-third  of  the 
solution  when  the  needle  is  one  third  to  halfway  in,  we  will 
anaesthetize  the  lingual  nerve,  the  rest  being  deposited  into  the 
pterygo-mandibular  space,  through  Avhich  the  adveolar  nerve 
and  vessels  pass,  that  is,  when  the  needle  is  inserted  to  its  full 
extent,  by  slow  and  even  pressure,  while  moving  the  syringe 
slightly  back  and  forth. 

If  you  want  anaesthesia  of  the  alveolar  nerve  only,  we  do 
not  inject  until  the  needle  is  inserted  to  its  full  extent,  so 
avoiding  anaesthesia  of  the  lingual  nerve,  depositing  1.5  c.c. 
at  the  alveolar  nerve.  This  gives  anaesthesia  of  one  half  of 
the  mandible,  but  on  account  of  anastomosis  of  the  nerve  from 


Fig  54.  Technique  of  inserting  the  needle  for  the  pterygo-mandibular  injection.  1,  2  and  3 
on  the  right  side;  4,  5  and  6  on  the  left  side;  1  and  4,  feeling  of  the  internal  oblique  line; 
adjusting  position   of  2   and   5,  the   syringe  parallel   with  the  ramus;   3  and  6,  reaching  the 

pterygo-mandibular   space. 


56 


CROWNS   AND   BRIDGES 


the  other  side  in  the  median  line,  the  incisor  teeth  remain  often 
slightly  sensitive.  Usually  an  exposure  can  be  made,  however, 
and  then  the  nerve  can  be  anaesthetized  easily  by  pressure 
anaesthesia.  To  get  complete  anaesthesia  of  this  part,  an  ad- 
ditional injection  into  the  mental  fossa  is  required. 

The  pterygo-mandibular  injection  is  the  least  painful,  and 
most  ideal,  as  the  injection  is  made  at  a  place  distant  from  the 
field  of  operation.     The  first  sign  of  success  occurs  in  a  few 


Fig.  55.     Sulcus  mandibularis  with  needle,  which  is  inserted  one  centimeter  over 

the   occlusal   surface. 


minutes,  when  the  patient  complains  of  numbness  of  the  lip, 
and  if  the  lingual  nerve  has  been  anaesthetized,  of  the  tongue. 
The  anaesthesia  starts  in  the  median  line  of  the  lips,  and 
works  backwards.  It  occurs  in  fifteen  and  twenty  minutes, 
is  the  deepest  between  thirty  and  forty  minutes,  but  lasts  one 
hour.  For  longer  anaesthesia  inject  two  syringes  full  or  4  c.c. 
at  once.  After  one  hour  the  anaesthesia  decreases  gradually, 
and  normal  sensation  occurs  in  from  thirty  to  sixty  minutes. 


ORAL   ANAESTHESIA 


57 


2.  Buccinator 
Injection 


To  anaesthetize  tlie  buccal  part  of  the  gum 
of  the  first  and  second  molar  in  the  lower  jaw, 
supplied  by  the  buccinator  nerve,  we  inject 
directly  into  the  mucous  membrance  supplied 
by  it. 


Sometimes  the  maxillary  first  and  second  mo- 
lar cannot  be  anaesthetized  hy  the  infiltration 
method  on  account  of  the  root  of  the  zygo- 
matic process,  thickening  tlie  bone  over  their 
roots.  In  these  cases  as  well  as  when  the 
teeth  are  in  severe  pathological  condition,  the  zygomatic  injec- 
tion is  recommended.      (Figure  56.) 


3.  Zygomatic 
Injection 


Fig.   56.     Photograph    showing   the   posterior   superior  alveolar   branches,    which 
enter  small  foramina  to  supply  the  three  molar  teeth.     An  extra  branch  supplies 

the  gum. 

Palpitate  the  zygomatic  process  of  the  maxilla,  preparing 
the  place  of  insertion,  which  is  distal  to  the  first  molar  as  above, 
and  sliding  the  long  needle  upward,  backward,  and  inward,  de- 
positing the  solution  while  injecting.     In  this  manner  the  two 


58 


CROirNS   AND   BRIDGES 


posterior  superior  alveolar  nerves  are  crossed  by  the  direction 
of  the  needle,  which  produces  anaesthesia  in  the  three  molars 
and  buccal  part  of  the  gum.  Inject  2  c.c.  Anaesthesia  occurs 
in  ten  minutes  and  lasts  one  hour. 

This  injection  is  only  used  in  severe  cases  to 
4.  Infra-orbital  avoid  injecting  into  pus  areas.  Palpitate  the 
Injection  infra-orbital  foramen,  and  place  the  tip  of 

one  finger  over  it.  With  another  finger  re- 
tract the  lip,  and  prepare  the  place  for  insertion  of  the  needle. 
Start  high  in  the  canine  fossa,  between  cuspid  and  first  bi- 
cuspid, and  push  the  needle  along  the  bone  till  felt  under  the 
finger  tip.  While  compressing  the  soft  tissue  with  the  finger 
tip,  inject  slowly,  forcing  the  solution  into  the  foramen.  Use 
1  c.c.  Anaesthesia  occurs  in  ten  minutes  in  the  cuspid  and  in- 
cisors of  the  respective  sides. 


Fig.  57.     Palate   of   an  adult.     Note  location   of  incisive   and  palatal   foramina. 


If  anaesthesia  of  the  first  part  of  the  palate 
5.  Incisive  and  palatal  gum  is  desired,  we  insert  the 

Injection  needle  in  the  median  line,  between  the  two 

upper  central  incisors.  Push  it  along  the 
bone  and  you  cannot  fail  to  get  into  the  incisive  foramen.  A 
few  drops  produce  anaesthesia  in  five  minutes. 


ORAL   ANAESTHESIA  59 

To  get  anaesthesia  of  tlie  jjosterior  palatal 
6.  Post  Pala-  part  of  the  gum,  the  needle  is  inserted  over 
tine  Injection       the   inferior   part   of    the   third    molar    (in 

children,  over  the  last  molar  present),  work- 
ing slightly  upward  and  backward.  A  few  drofjs  are  sufficient. 
If  more  than  0.3  c.c.  is  injected,  anaesthesia  of  the  soft  palate 
occurs,  which  is  undesirable. 

G.    AFTER-EFFECTS 

If  there  are  after-effects,  they  come  from  unclean  instru- 
ments, deteriorated  drugs,  false  technique,  injecting  into  patho- 
logical tissue,  injecting  into  muscle  tissue,  or  from  too  large 
percentage  of  suprarenin. 

They  are  swelling  which  disappears  without  treatment,  and 
pain  which  can  come  from  above  sources,  or  from  injection  dur- 
ing or  after  the  operation.  Such  an  injection  is  also  invited 
by  too  great  anaemia,  produced  by  too  large  percentage  of  supra- 
renin. Pain  is  relieved  by  cold  applications,  and  administering 
of  aspirian  and  trigeminin. 

I  have  used  local  anaesthesia  in  children,  and  in  adults  up 
to  eighty,  in  patients  who  collapsed  from  cocain,  and  wdio 
have  been  warned  not  to  have  another  injection,  and  I  have 
repeatedly  used  it  on  patients  with  severe  heart  and  pulmonary 
disorders  of  all  kinds.  In  these  cases  you  can,  to  go  entirely 
safe,  decrease  the  amount  of  suprarenin.  If  you  are  perfect 
in  the  technique  and  eliminate  any  danger  of  infection,  you 
have,  however,  little  to  fear  of  ill-  or  after-effects.  Anyone  that 
is  beginning  to  use  local  anaesthesia,  should  start  with  a  simple 
case,  such  as  an  upper  bicuspid  or  incisor,  and  gradually,  as  he 
gets  the  results  and  confidence,  take  more  difficult  cases. 

PULP  REMOVAL:  PRESSURE  ANAESTHESIA 

Apply  the  rubber  dam  and  cut  an  opening  directly  over  the 
pulp.  This  is  not  such  a  painful  operation  if  one  takes  time 
and  uses  sharp  new  burs.  Enter  a  tooth  if  possible  where 
there  is  no  decay;  if  entering  a  tooth  through  carious  dentin  it 
is  best  to  remove  all  decay  before  forcing  the  cocain  into  the 
pulp  chamber :  this  is  to  avoid  infection.  If  possible  obtain  an 
exposure,  place  the  cocain  into  the  opening  and  moisten.    With 


60  CROWNS  AND  BRIDGES 

a  ball  of  soft  vulcanite  rubber  force  the  cocain  into  the  tooth. 
This  should  be  done  first  with  a  slight  pressure,  which  must 
be  gradually  increased  to  a  considerable  force. 

Specially  prepared  cocain  or  novocain  tablets  are  most 
convenient  to  handle. 

After  the  pulp  has  been  anaesthetized,  open  the  pulp  cham- 
ber or  root  canal  entrance,  remove  the  pulp,  wash  the  canal 
with  alcohol,  dry  and  fill  permanently  at  the  same  sitting. 

TREATMENT  FOR   HYPERSENSITIVE  DENTIN 

We  are  indebted  to  Dr.  J.  P.  Buckley  for  giving  us  a  safe 
and  reliable  remedy  for  hypersensitive  dentin.  It  consists 
of: 

Neothesin   (CH3)2N    (CyH^)  (C2H5)  OCO  (C^n^),  HCl. 

Trioxymethylene   (CH20)3 

Thymol  CgHg  (CH3)    (OH)    (C3H7) 

This  desensitizing  paste  may  be  used  with  perfect  safety  in 
all  cases  of  hypersensitive  dentin  where  the  pulp  is  not 
diseased. 

In  cases  where  we  do  not  want  to  make  a  Novi^cain  in- 
jection in  order  to  enter  a  sensitive  tooth,  the  desensitizing 
paste  will  make  the  operation  painless. 

When  entering  a  tooth  through  a  decayed  spot  for  the  pur- 
pose of  enlarging  the  cavity  for  an  inlay,  or  to  make  an  ex- 
posure of  the  pulp  for  the  removal  of  same,  it  is  not  necessary 
to  remove  any  of  the  sensitive  decayed  dentin  in  order  that 
the  desensitizing  paste  can  do  its  work. 

All  that  is  necessary  in  order  to  obtain  the  desired  result 
is  to  dry  the  cavity  and  the  surrounding  tooth  surface,  place 
the  paste  over  the  carious  dentin  and  seal  same  with  a  good 
sticky  cement.  The  j)aste  should  remain  twenty-four  to  forty- 
eight  hours.  No  harm  will  follow  if  the  paste  should  remain  in 
the  tooth  longer. 

If  the  paste  has  been  sealed  hermetically  the  result  obtained 
is  most  pleasing;  it  is  as  painless  as  when  working  on  a  pulp- 
less  tooth. 

For  very  large  cavity  preparations,  such  as  for  inlay  abut- 
ments, it  may  be  necessary  to  make  a  second  application  of  the 
paste. 


VI.  GENERAL  TECHNICAL 
MANIPULATION 

1.    SELECTING   OF  SHADES 

First  of  all  the  teeth  should  be  cleansed  and  polished,  then 
compare  them  with  the  shade  guide.  The  teeth  of  the  shade 
guide  have  to  be  moistened  so  as  to  get  the  same  condition  as 
in  the  mouth.  It  is  well  to  have  the  artificial  teeth  rather  a 
little  darker  than  lighter,  because  darker  teeth  don't  stand  out 
as  light  ones  do.  The  natural  teeth  also  have  the  tendency  to 
darken  with  age.  The  cuspids  as  a  rule  are  darker  than  the  rest 
of  the  teeth,  especially  do  they  show  a  great  deal  of  yellow 
on  the  neck.  If  metal  backings  are  used  on  the  teeth,  try  the 
selected  tooth  with  the  backing.  To  make  sure  of  the  right 
color  effect,  this  should  be  done  before  grinding. 

2.  TAKING  BITE  FOR  GROWN  AND   BRIDGE   GASES 

When  bands  or  abutments  are  in  place,  press  a  roll  of  soft 
wax  against  the  opposite  tooth  or  teeth. 

This  roll  of  wax  must  be  long  enough  to  extend  over  the 
teeth  (idjoinwfj  the  crowns  or  the  abutments  for  the  bridge. 
(Figure  94.) 

Have  the  patient  bite  into  the  soft  wax,  and  then  tell  him 
to  press  the  tongue  against  the  wax.  Press  the  wax  at  the 
same  time  on  the  buccal  surface  against  the  teeth  with  the 
finger;  make  sure  that  the  patient  gives  the  correct  bite  by 
watching  the  opposite  side. 

When  cold,  remove  carefully. 

3.  TAKING    OF    IMPRESSION    FOR    CROWNS  AND 

BRIDGE  CASES 

First  of  all  make  sure  that  the  band,  or  the  bridge  abut- 
ments, are  in  their  proper  position.  In  removing  the  wax  bite 
the  abutments  are  sometimes  pulled  out  of  their  position,  and 


Fig.   58. 


Plaster   impressions   after   washing  trays   and   broken   pieces   with   hot 
water. 


Fig.  59.     Plaster  impressions  after  pieces  are  put  back  in  place,  and  held  there 

with   sticky   wax. 


Fig.  60.     Plaster  impressions  after  casting,  showing  how  the  impression  was  cut 
in  the  mouth,   lengthwise  over  the  ridge,  and  vertically  in  the  cuspid  regions. 


GENERAL    TECHNICAL    MANIFULATJOX  63 


care  must  be  takiMi  to  i^et  tlieiii  hack  in  tlicii'  \ni>[n^i'  jjlaces 
before  taking  the  impression. 

Select  an  Impression  tray  of  proper  size. 

Take  a  plaster  impression  of  the  bridge  space  and  the  teeth 
adjoining  the  abutments. 

For  large  bridges,  take  impression  of  entire  upper  and  lower 
jaws.  The  broken  pieces  of  a  plaster  im])ression  and  the  traj 
should  be  thoroughly  washed  by  running  liot  water  over  them, 
to  insure  proper  replacement  of  all  the  pieces.  (See  Figures 
58,  59,  60. ) 

Before  placing  crown  abutments  back  into  the  plaster  im- 
pression, make  sure  that  the  crowns  are  filled  in  with  solder  to 
reinforce  the  grinding  surface,  and  that  all  flux  is  boiled  out  in 
acid. 

Place  the  abutments  carefully  in  their  places,  also  the 
broken  plaster  pieces,  using  sticky  wax  to  hold  them  there. 
(Figure  204.) 

Varnish  impression  carefully. 

Fit  pins  or  staples  into  the  crowns,  to  prevent  them  from 
breaking  off  the  plaster  model. 

Pour  impression  with  plaster  and  Portland,  plaster  and 
pumice,  or  some  other  good  investment  material. 

4.     MOUNTING    GROWN    AND    BRIDGE    CASES    ON 

ARTICULATOR 

For  large  cases  impressions  of  the  entire  upper  and  lower 
jaw  should  be  taken,  and  the  case  is  to  be  mounted  on  an 
anatomical  articulator,  using  the  face  bow  to  get  the  right 
bite.      (Figure  61.) 

Small  cases  should  also  be  mounted  on  anatomical  crown 
and  bridge  articulators. 

In  placing  the  wax  bite  on  the  model,  procured  from  the 
impression,  care  should  be  taken  to  cut  away,  with  a  warm 
spatula,  all  wax,  which  would  interfere  with  the  proper  seating. 

The  models  are  fastened  to  the  articulators  with  plaster. 

After  the  plaster  has  set,  soften  the  wax  in  warm  water 
before  opening  the  articulator. 

Protect  occluding  plaster  teeth  with  tin-foil. 


64 


CROWNS   AND   BRIDGES 


Fig.  61.     Case  mounted  on  anatomical  articulator  by  means  of  a  face  bow. 

5.    SELECTION  OF  TEETH 

Select  the  teeth  according  to  the  length  of  tl^e  bite,  the 
width  of  the  abutments  to  restore  the  normal  fullness  of 
the  face  and  other  conditions  caused  b}^  the  loss  of  teeth,  such 
as  a  long  or  short  lip,  etc.  Be  sure  that  the  color  is  satisfac- 
tory before  grinding  the  teeth  to  place.  With  facings  it  is 
advisable  to  place  a  gold  backing  on  one  or  two  teeth,  and 
try  them  in  the  mouth,  as  very  often  the  backing  changes  the 
color. 

6.    GRINDING  OF  TEETH 

No  matter  what  type  of  tooth  is  used,  it  is  best  in  all  cases 
to  rough-grind  the  teeth  into  position  first,  and  try  them  in 
the  mouth  in  wax.  Kearrange  the  teeth  in  wax,  if  necessary. 
(Figure  207.)  Then  only  grind  the  occlusion.  When  facings 
are  used,  allow  between  the  bite  about  24  gauge  thickness  for 
backings  of  same.  For  box  teeth  such  as  Davis  or  Goslee  type 
teeth,  allow  for  thickness  of  box  on  gum,  or  saddle.  (Figures 
148  and  208.) 

To  Enlarge  Holes  in  Porcelain  Crowns 

Very  often  we  find  it  necessary  to  enlarge  the  hole  in  a 
detachable  porcelain  crown  to  make  it  line  up  with  the  post 


GENERAL    TECHNICAL   MANIPULATION  65 


in  tlic  root.  Tin's  is  Ix'st  accoiiiplislKMl  \\illi  an  S.  S.  Wliitc 
Number  1  Diamond  Point,  or  with  carborundum  points.  In 
either  case  use  plenty  of  water  and  do  not  press  too  long  and 
too  hard  at  one  place,  as  this  will  spoil  the  cutters  or  stones. 

7.     BACKING  OF  TEETH 

When  teeth  are  perfectly  ground  and  waxed  to  position 
to  the  abutments,  and  the  spaces  on  to  tlie  model,  varnish  or 
shellac  the  front  of  the  plaster  model,  and  pour  a  plaster  core 
or  jacket  over  same.  (Figures  65  and  208.)  Boil  out  the 
wax  and  observe  whether  the  distance  between  the  teeth 
and  the  abutments,  between  the  saddle  or  the  gum,  is  sufficient 
for  the  gold  backing,  or  box,  and  reinforcement  of  the  same,  to 
get  sufficient  strength.  If  the  distance  is  not  right,  now  is  the 
time  to  correct  it,  by  grinding  away  from  the  back  of  the 
tooth.  This  is  the  i)lace  to  give  strength  to  the  Ijacking  or 
the  box.  ( Figure  208. )  Now  remove  the  teeth  from  the  core 
and  swage  the  backing  or  the  box.  Cut  the  first  backing  of 
sufficient  length  to  reach  from  the  cutting  edge  to  the  gum 
line.  When  the  teeth  are  in  the  core  on  the  model,  we  can  cut 
and  fit  all  the  backings  correctly,  where  they  should  reach. 
This  makes  the  soldering  simple  and  gives  more  strength. 
The  first  backing  should  be  24  karat  31  gauge.  Anneal  the 
gold,  punch  holes  first  and  swage  backing  to  the  tooth.  (Fig- 
ure 62.)      Do  extend,  but  do  not  have  backing  bent  over  the 


A  B 

Fig.  62.     A,  Facing  with  single;   B,   Facing  with  double  backings. 

cutting  edge.  Many  facings  are  weakened  or  cracked,  when 
swaging  the  backings.  When  swaging,  make  sure  to  have  the 
facing  well  supported  in  the  cup  of  the  swager,  from  the  cutting 
edge  to  the  labial  cervical  margin.  Examine  the  facing  for 
defects  closely  before  soldering. 


66 


CROWNS   AND   BRIDGES 


8.     REINFORCING  OF   BACKINGS 

Cut  a  backing  out  of  26-gaiige  18-karat  gold  plate  to  extend 
from  the  pins  to  the  cutting  edge  over  the  first  backing  of  jDure 
geld.  Do  not  attempt  to  swage  this  second  18-karat  backing 
on  thin  or  narrow  teeth,  as  these  facings  are  liable  to  crack. 
Bend  18-karat  backing  in  such  cases  approximately  with  pliers. 
Remove  both  backings  from  the  tooth  and  unite  them  by  flowing 
18-karat  solder  in  between  so  it  will  shoM'  at  all  edges.  (Fig- 
ure 63.)      Boil  in  sulphuric  acid  20%.     Replace  backings  to  the 


Fig.   63.     Soldering  the   two   backings   in   the    flame. 


facings  and  burnish  it  around  the  pins  with  a  hollow  burnisher. 
Do  not  cut  or  split  the  pins.  After  soldering  the  backing  to 
the  pins,  either  in  sections  or  in  one  soldering  with  the  abut- 
ments, file  the  backing  at  a  right  angle  to  the  level  of  the  facing. 
It  is  advisable  to  reinforce  Goslee  or  similar  tooth  boxes 
also  with  18-karat  26-gauge  plate,  to  strengthen  the  back- 
ing over  the  pin  (Figure  139B)  at  arrow-point  b,  and  to  pre- 
vent polishing  through  at  the  weakest  point  of  the  box  at  arrow- 
point  A.  If  the  box  is  not  reinforced,  at  b  the  post  with  the 
thin  backing  often  breaks  away,  and  at  the  point  A  the  solder 


GENERAL    TECH  MCA  L   MANUAL  LATION  67 

does  not  always  covit  sufficiently  to  prevent  a  hole  to  be  pol- 
ished tlirongh.  The  IS-karat  extension  backing  prevents  both 
of  these  events.  This  same  reinforcement  is  also  useful  "when 
using  a  Davis  type  crown  as  an  abutment.      (Figure  131)10  i. 

The  Goslee  platinum  or  gold  ])Ost  with  shoulder  will  also 
prevent  the  post  from  breaking  away  from  the  box.  Other  use- 
full  suggestions  in  box  construction  for  Goslee  teeth  are  fur- 
nished by  the  dealers  of  these  teeth. 

The  most  commonly  used  gold  solders  in  l)ridgework  are  the 
22-l?;arat,  20-karat,  and  IS-karat.  The  higher  karat  gold 
is  used  to  prevent  discoloration  of  the  joints  of  bands,  and  all 
metal  crowns,  and  also  to  prevent  refiowing.  For  example, 
use  a  higher  karat  gold  solder  for  the  soldering  in  constructing 
abutments,  and  the  lower  karat  (IS-  or  20-karat  as  a  rule)  to 
unite  the  abutments  and  dummies. 

9.    TO  PREVENT  THE  CRACKING  OF  FACING 

When  setting  up  a  bridge  case  Avitli  facings,  allow  small 
spaces  between  the  teeth,  so  that  they  do  not  touch  each  other ; 
this  allows  for  expansion  of  the  porcelain  caused  by  the  heating 
of  the  case,  and  when  soldering.  Take  an  iron  or  german  silver 
band  about  ^  inch  high  and  invest  the  bridge  into  this  (Figure 
208). 

Have  the  investment  of  small  size  and  expose  by  cutting 
away  the  investment,  the  surface  to  be  soldered  as  much  as  pos- 
sible. Remove  all  wax  by  pouring  boiling  water  over  it.  Do 
not  hurn  the  wax  out  over  the  flame,  because  this  will  make 
the  gold  surface  unlcean.  Examine  the  invested  bridge  once  more 
before  heating,  to  see  if  any  part  of  the  porcelain  is  exposed, 
where  the  backing  should  extend;  cover  this  place  with  a  thin 
piece  of  platinum  or  pure  gold  plate.  Gold-foil  is  also  very 
useful  to  cover  such  exposed  places;  be  sure  to  pack  the  foil 
thick  enough,  so  that  it  will  not  burn  away  under  the  flame 
when  soldering.  Large  spaces  such  as  between  tooth  boxes  and 
saddles  are  best  packed  with  Alexander  gold;  this  gold  will 
pack  in  like  wax,  and  suck  up  the  solder.  Tooth  boxes  on 
saddles  are  best  invested,  and  soldered,  leaving  both  the  front 
and  back  open.  (Figure  64.)  This  enables  us  to  solder  from 
both  sides.     Large  backings  for  gum  blocks  to  be  soldered  to 


68 


CROWNS   AND   BRIDGES 


gold  plates  or  saddles  are  also  best  invested  in  the  same  way. 
Heat  tlie  case  over  a  suitable  flame  slowly,  so  that  the  porcelain 
will  not  crack.  Always  let  the  bridge  cool  slowly  after  solder- 
ing, for  the  same  reason. 


A 


Fig.    64.     Showing    a    Goslee    tooth    saddle    bridge    invested    ready  to    solder. 

Figure  A  shows  the  back  of  bridge,   Figure   B   the   front  of  bridge  open  from 

both   sides,  and  partly  packed  with   Alexander  gold.     This   kind   of  investment 

permits   perfect   soldering   on   both   sides. 


When  ready  for  soldering,  flrst  test  if  the  case  is  dryed  out 
and  hot  enough  to  solder  by  sprinkling  powdered  borax  on  the 
metal  surface.  If  the  borax  puffs,  or  boils  up,  the  case  is 
ready,  otherwise  heat  longer;  add  the  borax,  and  also  solder, 


GENERAL    TECHNICAL   MANIPULATION  69 


and  place  the  case  on  the  sohJeriii^^  block  so  that  tiie  soldering 
does  not  interfere  with  the  laws  of  gravity.  Tlie  solder  will 
flow  downwards  and  also  towards  the  hottest  part,  therefore  tip 
tlie  investment  accordingly,  and  apply  the  heat  where  you  want 
the  solder  to  flow.  A  poker,  such  as  a  broken  excavator,  will 
also  help  to  lead  or  push  the  solder  when  melted  to  the  right 
place  and  is  very  lielpful.  Keep  sprinkling  dry  borax  during 
soldering  to  tlie  bridge  and  sohler  as  needed.  Soldering  fluids 
should  not  be  used  on  a  hot  case  for  two  reasons :  first,  if  used 
on  backings  witli  facings,  tlie  moisture  and  cold  may  crack  the 
facing.  Secondly,  applying  a  fluid  to  hot  metal  with  a  brush, 
the  end  of  the  brush  will  burn,  and  leave  a  carbon  deposit  that 
will  prevent  good  soldering.  In  soldering  gold  bands,  put  the 
soldering  fluid  on  the  surface  when  the  metal  is  cold,  then  place 
the  solder  and  melt  in  the  open  flame,  or  with  blow-pipe. 

10.    SOLDERING   BRIDGE  IN  SECTIONS 

To  overcome  contractions  on  bridges,  it  is  necessary  to 
solder  the  dummies  in  sections,  then  replace  these  soldered  sec- 
tions on  the  abutments  and  unite  the  whole.      (Figure  65.) 


Fig.  65.     Showing  a  full  upper  bridge.     The  teeth  have  been  soldered  together 

in   three   sections   to  prevent   contraction.     Case   is    ready   for   final   assembling 

and  soldering  to  the  bridge  abutments. 


70  CROWNS  AND   BRIDGES 

11.    CASTING 

The  introduction  of  pressure  easting  by  Taggart,  has  so 
revolutionized  many  methods  of  operative  dentistry,  crowns 
and  bridgework,  that  we  may  call  its  introduction  the  most 
remarkable  period  of  modern  dentistry.  In  crown  and  bridge 
work,  we  can  now  use  inlays  with  posts,  as  abutments,  cast 
vault  and  sub-lingual  bars,  cusps  to  crowns,  dummies  for  sani- 
tary bridges,  saddles  for  saddle  bridges,  etc.,  etc. 

Though  perfect  results  can  be  obtained  Avith  small  and  me- 
dium sized  pieces,  it  is  not  practical  to  undertake  too  com- 
plicated and  large  castings.  For  example,  it  would  not  be 
advisable  to  cast  too  many  dummies  to  the  abutments,  because 
these  would  be  drawn  out  of  position  by  contraction.  Expe- 
rience and  good  judgment  must  guide  the  selection  of  the 
method.  Like  with  all  new  inventions,  we  can  only  find  its 
real  usefulness  by  experiments.  So  also  in  the  castiiig  process, 
the  pendulum  swung  over  to  one  side ;  first  everything  that  we 
formerly  would  solder,  had  to  be  cast :  small  and  large  pieces 
of  bridgework,  with  and  without  teeth,  upper  and  lower,  full, 
and  partial  gold  plates,  with  or  without  teeth,  clasp,  bars,  boxes, 
saddles,  dummies,  croAvns,  etc., — everything  had  to  be  tried 
and  tested  before  the  pendulum  swung  back  the  other  way, 
and  we  are  now  satisfied  that,  after  all,  swaged  crowns,  swaged 
cusps,  swaged  plates  and  teeth  soldered  to  same,  are  still  su- 
perior to  casting  in  many  cases,  with  the  exception  of  small 
cases,  such  as  the  casting  of  single  crowns,  tooth  boxes,  saddles, 
sanitary  bridge  supplies,  vault  and  sub-lingual  bars,  inlays,  etc. 
I  prefer  to  swage  and  solder  all  large  pieces  as  of  old. 

To  get  perfect  results  we  have  to  watch  carefully  all  the 
small  details  connected  with  the  making  of  the  wax  pattern, 
the  investing,  setting,  drying  and  heating  of  the  case,  and  this 
is  of  greater  importance  than  the  use  of  any  special  make  of 
casting  machine.  Beautiful  results  can  be  obtained  with  the 
simplest  as  well  as  the  most  expensive  casting  machine,  and 
whether  using  vacuum,  steam,  centrifugal  power  or  gas  pres- 
sure. A  paper  reviewing  the  pressure  casting,  compiled  from 
the  recent  "American  Literature"  has  been  read  before  Section 
V  at  the  Sixth  International  Dental  Congress,  London,  1914, 
and  a  report  of  this  can  be  found  in  the  "Items  of  Interest," 


GENERAL    TECEINICAL   MAKIPLLATIOS  71 


Volume  XXXVI,  No.  10,  October,  1914.  A  icporl  of  Dr.  Otto- 
lengin's  "Review  on  Coasting"  is  to  be  found  in  the  ''Items  of 
Interest,"  Volume  XXXVI,  No.  11,  November,  1014. 

TECHNIQUE 
Wax  form 

The  wax  form  is  either  carved  on  the  anatomical  articulated 
model,  or  in  cases  of  inlays,  by  the  direct  (from  the  mouth),  or 
preferably  by  the  indirect  method.  In  I  In-  latter  «-asr  an  amal- 
gam die  is  made. 

Taggart's  wax,  also  Kerr's  blue  wax,  is  recommended. 
When  carving,  special  pains  should  be  taken  to  reproduce 
nature  as  far  as  possible.  All  the  cusps,  grooves,  fissures,  and 
sulci  should  be  imitated  from  extracted  teeth,  or  a  good  plaster 
model  of  perfect  teeth.  Not  only  should  the  casting  be  carved 
to  occlude  properly,  it  should  also  aUoto  nor)iial  lateral  moHoiK 
as  produced  in  mastication.  The  carved  piece  is  then  smoothed 
with  alcohol,  and  a  sprue  wire,  of  the  size  of  an  ordinary  pin, 
is  placed  in  the  most  bulky  part.  Place  the  sprue  wire  into 
the  hole  in  the  sprue  and  hold  it  with  wax. 

Investing 

The  process  of  investing  the  wax  is  very  important,  and  all 
small  points  should  be  carefully  observed  to  get  the  most  per- 
fect results. 

Taggart's  special  investment  compound  is  highly  commen- 
dable.    Use  it  as  follows: 

Fill  the  large  cup  of  the  balance  scale  that  comes  with  the 
box  with  loose  powder  and  scrape  off  level  with  a  straight 
plaster  spatula.  Place  the  weighing  device  on  the  fulcram  and 
with  a  water  syringe  fill  the  small  cup  until  it  exactly  balances ; 
cover  the  powder  and  pour  the  water  into  a  clean  plaster  bowl, 
now  add  the  powder.  Spatulate  for  one  minute,  then  jar  and 
rotate  the  bowl  for  two  minutes  more.  On  account  of  the  fluid 
condition  of  this  mixture  this  prolonged  manipulation  permits 
all  the  air  and  gas  bubbles  to  come  to  the  surface.  The  inlay 
should  then  first  be  painted  with  the  investment  material,  and 
the  balance  is  poured  into  the  ring  in  such  a  manner  as  to 
permit  it  to  trickle  down  the  inside  of  the  ring.  Do  not  hurry 
the  work;  there  is  a  period  of  at  least  eight  minutes  during 
which  the  material  is  workable. 


72  CROWNS   AND    BRIDGES 

Let  the  investment  harden  for  about  twenty  minutes,  and 
then  place  it  over  a  small  flame,  heating  it  up  slowly.  As  soon 
as  the  wax  has  burnt  out,  cast,  or  let  the  flask  cool  and  cast 
later.  The  twenty  minutes  heat  gives  a  better  surface  than  if 
heated  too  long,  and  casting  in  a  cold  flask  prevents  feathers 
on  the  casting. 

Gold 

Use  coin  gold  for  inlay  abutments,  or  platinized  gold,  add- 
ing 2|%  platinum  to  the  j)ure  gold.  Use  18  or  20-karat  gold 
for  parts  of  bridgework.  Better  still  are  gold  alloys,  after 
Weinstein's  formula. 

1.  SOFT  ALLOYS   FOR   INLAYS,  ETC. 

(Melt  by  nitrous  oxide  or  ordinary  blow-pipe) 

Pure  gold 60-90  parts 

Plate  Number  2 10-40  parts 

according  to  hardness  desired. 

2,  HARD  ALLOYS   FOR    BRIDGEWORK 

(For  nitrous  oxide  blow-pipe) 

Pure  gold 80.0  parts 

"      platinum   rhod 8.5       " 

"      palladium     3.5      " 

"      silver     2.0       " 

"      copper     G.O       " 

(For  gas  and  air  blow-pipe) 

Pure  gold    80.5  parts 

"      platinum  rhod 6.5      '^ 

"      palladium     2.5       " 

"      silver     2.5       " 

"      copper     8.0      " 

100.0 

12.     POLISHING  OF  CROWNS  AND   BRIDGES 

In  order  to  attain  the  highest  finish  on  a  crown  or  bridge, 
care  and  patience  must  be  used  in  properly  filing,  stoning  and 
sand-papering  before  applying  felt  cones  and  brushes  for  the 
final  polish.  No  matter  how  smooth  your  soldering  appears, 
all  soldered  surfaces  should  be  stoned.     In  spite  of  boiling  in 


GENERAL    TECHNICAL   MANIPULATION  73 


acid,  some  borax  and  also  a  skin-like  porous  coverinj^  of  these 
surfaces  is  not  always  removed  by  the  acid.  Carborundum 
stones  in  the  dental  engine  or  lathe  attachments  are  the  handi- 
est in  reducing  gold  and  getting  smootli  surfaces.  While  rub- 
ber carborundum  wheels  are  best  to  use  for  the  inter-dental 
spaces,  between  crowns  and  near  cutting  edges,  sand-paper 
disks  on  a  mandrel  are  also  of  great  help. 

Before  polishing,  always  stone  and  finish  the  deep  fissures 
and  the  inter-dental  spaces  first.  These  inter-dental  or  so- 
called  wash  spaces  can  be  reached  best  by  applying  pumice 
and  water,  or  tripley  rubbed  on  twine.  Hold  these  with  the 
left  hand,  and  with  tlie  right  hand  work  the  bridge  against  the 
twine  in  a  quick  up-and-down  motion,  until  the  desired  result  is 
obtained.  Now  polish  the  large  surfaces  with  pointed  or  flat 
felt  cones,  pumice  and  water,  tripley,  or  otlier  polish;  then  go 
over  tlie  entire  bridge  with  a  brush  Avheel  until  all  the  scratches 
are  removed.  Wasli  all  tlie  pumice  off  and  apply  whiting  or 
rouge  with  a  soft  ])rush  or  polishing  wheel,  then  wash  bridge 
again  with  warm  water,  and  gold  plate  same. 

13.     GOLD  PLATING  OF   CROWNS  AND   BRIDGES 

It  is  of  great  importance  to  gold  plate  soldered  crowns, 
also  all  bridges.  The  deep  fissures,  the  soldered  joints,  such 
as  between  the  crowns  and  the  dummies,  and  the  gold  in  the 
inter-dental  spaces  show  the  first  effect  of  oxidation  in  the 
mouth.  Large  surfaces  and  especially  masticating  surfaces  are 
kept  bright  in  polish  and  color  through  the  constant  rubbing 
and  friction  caused  by  the  masticating  and  cleaning  process. 
When  a  bridge  is  properly  gold  plated  with  24-karat  gold  plate, 
we  have  a  piece  of  work  which  is  of  uniform  color,  and  the 
plating  will  protect  all  the  deep  fissures  and  soldered  joints 
from  discoloration  and  oxidation  for  many  years.  There  are 
various  plating  outfits  offered  for  sale  on  the  market.  How- 
ever, it  is  very  simple  and  easy  to  make  your  own  apparatus, 
which  will  do  good  service.  Here  is  one  I  have  used  for  many 
years.      (Figure  66.) 

Use  the  following  solution  in  the  jar : 

Chloride  of  gold 30  gram 

Cyanide  of  postassium 60      " 

'^^t^^  8  ounces 


74 


CROff'NS   AND    BRIDGES 


Fig.  66.     Gold-plating  outfit,  of  simple  construction,  for   110-volt  direct  current, 

using  a  110-volt '16-candle  power  lamp  and  one  220-volt  32-candle  power  lamp  to 

reduce   the   current.      (See  page   73.) 

14.    FITTING  OF   BRIDGES  IN  THE  MOUTH  AND 
WEARING  THEM   FOR  A  DAY  OR  TWO 

In  fitting  large  bridges  we  often  find  that  the  finished  bridge 
will  not  go  in  its  proper  place,  or  as  we  may  term  it,  is  not 
seated.  This  may  be  due  to  some  carelessness  in  putting  the 
abutments  in  their  proper  places  in  the  plaster  imj)ression,  or 
it  may  be  caused  by  a  broken  off  abutment   on  tihe  plaster 


GENERAL    TECHNICAL   MANIPULATION  75 


model,  and  when  tliis  iil)ntnient  was  not  put  back  in  tlie  exact 
position,  where  it  behjiioed.  Anotlier  cause  rnay  be  that  the 
bridge  has  contracted  in  the  final  soldering.  (See  Figure  65.) 
If  it  should  l)e  necessary  to  refit  the  bridge,  cut  some  of 
the  abutments  off,  place  them  in  the  mouth,  take  another  bite, 
and  impression,  and  resolder.  But  these  mechanical  defects 
of  tlie  bridge  aboveiiientioned,  are  not  tlie  only  causes  that  may 
prevent  a  bridge  from  going  into  its  proper  place.  One  of  the 
commonest  causes  is  the  side  shifting  or  moving  of  the  teeth  or 
roots,  to  which  tlie  abutments  have  been  fitted;  in  such  cases  it 
is  advisable  to  let  the  patient  wear  the  l)ridge  uncemented  for 
several  hours,  or  even  twenty-four  hours,  during  which  time  the 
teeth  will  readjust  themselves  to  the  bridge.  If  the  teeth  or 
root  canals  liave  not  been  lined  up  to  prevent  the  bridge  from 
getting  into  place,  it  is  best  to  start  all  over  again  and  use  more 
care.  Figure  201  shows  an  instrument  of  great  value  for  sucli 
cases. 

15.    CEMENTING  OF  CROWNS  AND   BRIDGES 

Never  try  to  cement  a  crown  or  bridge  until  the  same  has 
been  tried  and  is  correctly  seated.  Make  sure  that  the  apical 
end  of  the  roots  are  correctly  filled.  It  is  important  to 
know  the  working  qualities  of  the  crown  and  bridge  cement 
used,  its  color  effect  and  especially  its  setting  period.  Dry  the 
abutments  of  the  bridge,  and  wherever  there  is  a  saddle  or  deep 
inter-dental  space,  coat  these  places  Avith  a  thin  film  of  vaseline. 
(The  vaseline  will  prevent  the  lodging  of  cement  at  these  places 
after  the  bridge  has  been  cemented.)  Paint  the  gum  around 
abutments  with  camphor  phenol,  or  a  20%  solution  Novocain, 
and  dry  all  roots  and  teeth  which  are  used  for  abutments  by 
wiping  them  off  first  with  alcohol  and  then  applying  warm  air 
with  chip  blower  or  compressed  air.  This  overcomes  the  pain 
so  often  caused  by  the  cement.  Place  cotton  rolls  and  nap- 
kins around  the  teeth  to  be  crowned.  After  the  assistant  has 
mixed  the  cement  and  is  filling  in  the  different  crowns,  the 
operator  should,  with  a  suitable  instrument,  fill  cement  in  the 
root  canals  which  are  to  receive  post  crowns.  Do  not  mix  the 
cement  too  thick,  fill  the  crowns  even  full,  as  this  will  pre- 
vent the  arresting  of  air,  and  act  as  a  lubricant  to  slide  the 
crowns  into  place.     The  bridge  must  be  held  into  place  until 


76  CROPFNS  AND   BRIDGES 

the  cement  is  set.  If  the  operator  cannot  hold  the  bridge  in 
position  with  one  hand  while  he  burnishes  the  metal  caps  to 
place  with  the  other  hand,  before  the  cement  sets,  an  assistant 
should  hold  the  bridge. 

Color  of  cement  important 

The  color  of  cement  is  of  great  importance  when  open-faced, 
staple,  half  crowns,  with  post  or  inlay  abutments  are  used.  If 
a  brown  or  gray  cement  is  used  in  such  cases,  it  mil  often 
change  the  color  of  the  tooth.  To  prevent  this,  a  light  yellow 
cement  is  preferable,  which  will  sustain  the  natural  color  of 
the  tooth. 

16.     FINAL  ADJUSTING  OF   OCCLUSION 

The  correct  occlusion  of  a  crown  or  bridge  is  most  impor- 
tant, as  the  comfort,  the  service,  and  life  of  the  crown  or  bridge 
depends  on  this  to  a  great  extent. 

Have  the  patient  bite  in  the  various  ways  which  the  move- 
ments of  the  lower  jaw  permit;  ascertain  the  hard  striking- 
places  by  the  use  of  carbon  paper;  grind  them  carefully  witl;  a 
suitable  stone.  Be  sure  to  clear  the  cuspids  of  the  lateral  bite, 
as  these  are  the  ones  that  are  most  severely  affected.  In  a 
general  way  follow  the  directions  for  adjusting  the  bite  of  a 
crown  or  bridge  as  you  would  for  setting  up  teeth  on  an  ana- 
tomical articulator. 

17.    INSTRUCTION  TO   PATIENTS 

Patients  frequently  experience  more  or  less  difficulties  with 
new  bridges,  especially  if  they  have  been  without  teeth  for  a 
long  time.  If  large  bridges  are  jjut  into  a  patient's  mouth, 
they  feel,  as  they  often  express  it,  "all  teeth."  The  tongue 
which  was  used  to  a  large  space,  taking  up  the  room  of  the  lost 
teeth  and  extending  even  into  the  vestibulum  oris,  finds  itself 
suddenly  restricted  to  the  cavum  oris  proper.  It  often  takes 
several  weeks  before  the  tongue  gets  used  to  its  new  environ- 
ments. 

Mastication  is  another  feature  which  has  to  be  considered. 
If  many  of  the  molars  and  bicuspids  have  been  missing,  the 
patient  either  masticated  with  the  front  teeth,  or  swallowed 


GENERAL    TECHNICAL   MANIPULATION  77 


the  food  uncliewed.  JJotli  liabits  liave  to  he  corrected.  The 
patient  ought  to  be  instructed  to  use  tlie  hridj^e  and  to  masticate 
each  mouthful  of  food  properly.  In  tlie  l^egiiining-  this  may 
trouble  them,  as  tliey  may  not  have  used  that  side  and  the  teeth 
for  a  long  time.  But  gradually  the  need  is  supplied  by  nature, 
the  circulation  will  increase  in  tlie  alveolo-dental  membrane 
and  the  tissues  surrounding  the  teetii  will  be  strengthened  until 
they  are  all  able  to  fulfill  their  requirements.  It  is  of  great 
importance  that  tlie  occlusion  should  be  adjusted  for  proper 
masticating  antagonism.  Anatomical  articulators  should  be 
used  for  the  co)istrnctioi)  of  all  hrklrjes,  and  the  teeth  should 
be  readjusted  in  the  mouth  l)efore  and  after  the  bridge  is  set. 

18.     CARE   OF   BRIDGES 

Bridges  should  be  properly  cared  for  by  the  patient,  and 
should  receive  regular  attention  by  the  dentist.  Fixed  bridges 
can  be  cleaned  with  the  toothbrush,  dental  floss  and  cleaning 
tape,  in  combination  with  a  proper  tooth  paste.  Removable 
bridges  are  easy  to  keei)  clean,  that  is,  the  bridge  itself;  the 
abutments  and  gum,  however,  should  not  be  neglected,  and  re- 
ceive careful  brushing.  Brushing  of  the  gum  is  important  to 
stimulate  the  blood  circulation.  Massaging  the  gums  around 
removable  bridge  abutments  with  cotton  rolls  in  a  Kuroris 
holder  is  highly  recommended. 


VII.    SINGLE  CROWNS 

Whenever  there  is  a  croAvn  of  a  tooth  missing  or  badly 
decayed,  with  its  root  in  good  condition,  or  with  a  root  which 
yields  to  treatment  so  as  not  to  be  a  source  of  infection,  it  is 
safe  to  crown,  providing  the  bite  is  favorable.  There  are 
different  types  of  crowns  which  can  be  nsed  to  replace  such  a 
tooth,  and  they  are  made  for  different  conditions.  The  type  of 
crown  which  comes  nearest  to  the  ideal  condition,  without  tak- 
ing a  chance  as  to  its  practical  value,  should  be  selected.  The 
ideal  crown  has  the  following  qualities : 

Clean   surface. 

Not  irritating  the  gum. 

Esthetic  appearance. 

Kestoring  occlusion. 

Kestoring  contact  points. 

ALL  PORCELAIN  CROWNS 

These  are  the  most  ideal  crowns.  Porcelain  is  the  cleanest 
material  and  gives  the  best  effect.  If  propertly  fitted,  porcelain 
crowns  are  most  favorably  received  by  the  gum. 

TYPES  OF  ALL  PORCELAIN  CROWNS 

1.  Jacket  crowns. 

2.  Detached  post  crowns. 

Hand-carved  crowns. 
Stock  crowns. 

1.    JACKET  CROWNS 

Crown  I. 

This  crown  can  be  used  for  a  devitalized  tooth,  as  well  as 
for  a  tooth  with  a  live  pulp;  it  encloses  the  part  of  the  tooth 
extending  over  the  gum  like  a  jacket,  therefore  the  name. 

Its  use  is  largely  to  restore  malformed,  peg-shaped,  pitted, 
or  erosed  teeth,  but  can  be  used  to  replace  almost  any  tooth  in 
the  mouth,  if  tooth  or  root  is  rightly  trimmed  and  built  up. 


SINGLE   CROfrNS 


79 


Preparing  of  tooth 

To  XJrepare  the  tootli  for  a  jacket  ei'o\\  n,  cut  down  the  tooth 
to  pi'ocui'e  a  coiK^-shnjK'  A\'illi  shonI<lei-,  as  slioAvii  in  Figure 
67A,  I,  and  j;,  Til. 

The  mesial  and  distal  sides  of  the  tooth  are  hest  reduced 
with  a  wet  rubber  carborundum  disk  stone. 

Tlie  front  and  Itack  with  small  stones,  well  wetted,  cnttiu*; 
little  at  a  time. 


(A)  I 


III  IT 

Fig.  67A. 


(B) 


II 


III 


Fig.  67B. 


The  groove  is  cut  with  a  sharp  square-end.  plain  fissure  bur. 

To  cut  this  groove  well  under  the  gum  margin,  steady  the 
bur  and  handpiece  by  resting  the  thumb  on  the  adjoining  teeth, 
and  apply  steady  pressure  to  overcome  the  vibration. 

Impression  of  tooth 

Fit  a  seamless  copper  band  loosely  around  the  prepared 
tooth,  heat  the  end  of  a  Kerr  impression  stick,  and  press  this 
into  the  band  against  the  tooth. 

Chill  and  withdraw  carefully. 


80 


CROWNS   AND    BRIDGES 


Making  of  die 

Pack  the  impression  with  amalgam,  forming  a  cone-shaped 
extension.      (Fignre  67A.  I.) 

When  hard,  remove  the  impression  compound  and  trim 
the  end  of  the  die  cone-shape  as  per  Fignre  67A.  I.  This  is 
best  accomplished  with  a  sandpaper  wheel  on  the  lathe.  Oil 
the  die   ( the  cone-shaped  extension ) . 

Take  another  impression,  also  a  wax  bite  of  the  prepared 
tooth  and  the  adjoining  teeth,  and  place  the  amalgam  die  in 
the  impression  of  the  prepared  tooth  and  make  an  articulated 
model. 

Take  a  piece  of  1-1000  platinum  foil,  cut  and  shape  it  like 
Figure  67C,  I,  II. 


II  III  IV 

Fig.  67C.     Steps  for  jacket  crown. 


VI 


Trim  excess  of  foil  to  allow  fold  to  be  double  lapped. 

Make  a  matrix  with  a  double  folded  lap  to  the  mesial  or 
distal  side  of  the  tooth.  (Figure  67C,  III.)  Use  long- 
nosed  cotton  pliers  to  fold  the  foil. 

This  double  lapped  joint  does  not  need  to  be  soldered  and 
will  permit  perfect  forming  of  the  foil  to  the  die. 

Twist  the  upi)er  end  of  the  foil  (Figure  67C,  IV),  cut  off 
excess  but  allow  enough  for  closing  of  top. 

Form  the  foil  with  finger  pressure  to  the  die,  burnish  edges 
with  gold  burnishers. 

For  the  groove  use  a  fine  ball  burnisher,  getting  a  perfect 
adaptation  to  the  groove,  edge  and  sides.      (Figure  67C,  V.) 

Remove  foil  matrix  from  die. 

Trim  the  overhanging  edge  to  aV  overhanging  length. 

Replace  matrix  to  die,  and  reburnish  to  same. 

If  a  change  in  trimming  of  the  tooth  was  necessary,  the 
matrix  can  now  be  reburnished.  directly  on  the  tooth  in  the 
mouth. 


SINGLE   CRUfrNS  81 


Porcelain  to  matrix 

Build  body  porcchiiii  to  cover  the  whole  matrix  to  de«ired 
shape  of  crown.  Do  this  with  the  matrix  on  llie  die;  try  the 
crown  oil  model  for  desired  shape. 

Eemove  die  from  the  model  and  with  a  line  kuife  or  the 
pointed  end  of  a  thin  cement  spatula,  cut  a  deej)  groove  in  the 
porcelain  clear  around  the  base  of  the  crown,  clown  to  the 
matrix.      (Figure  67C,  VI.) 

This  cut  should  be  made  before  the  porcelain  is  dry. 

This  cut  is  the  most  important  step  of  the  whole  operation. 

This  cut  will  prevent  the  pulling  aAvay  of  the  matrix  from 
the  lower  edge  of  the  crown,  when  baking  the  porcelain. 

Now  remove  the  matrix  with  the  porcelain  from  the  die. 

Set  the  matrix  (covered  with  the  hodij  ])orcelain)  on  a 
small  tray  of  silex  and  bake. 

After  the  first  bake,  the  line  (Figure  67C,  VI I  will  show 
much  shrinkage  of  the  porcelain. 

Fill  in  this  line  with  hodi/  porcelain  first,  then  add  the 
enamel  porcelain  for  final  shape  and  color. 

Try  again  on  model  and  when  built  np  satisfactorily,  set 
crown  on  a  tray  with  silex  and  give  the  crown  the  final  backing. 

Kemove  the  foil  by  pulling  the  edges  towards  the  centre  of 
crown. 

Setting  of  jacket  crown 

Use  a  creamy  mixture  of  cement,  forcing  the  crown  with  a 
rotary  pressure  of  the  finger  to  place. 

Hold  crown  for  five  minutes. 

Do  not  allow  the  patient  to  bite  on  the  crown  until  after 
the  cementing. 

To  my  mind  this  is  the  most  esthetic,  the  strongest,  in  fact 
the  most  beautiful  crown  that  can  be  made. 


2.     DETACHED  POST  CROWNS 

Crown  II. 
HAND-CARVED   CROWNS 

The  best  in  appearance  is  the  hand-carved  crown.  It 
usually  does  not  need  much  fitting  to  the  tooth  or  root.  All  the 
small  details  of  the  adjoining  teeth  can  be  imitated  and  splen- 


82  CROPFNS  AND   BRIDGES 

did  results  be  obtained  in  shape,  in  color  effect  and  natural  ap- 
pearance.    The  technique  is  as  follows : 

Root  preparation 

Grind  the  root  as  for  a  post  crown. 

Fit  post  into  position  and  with  this  take  an  impression,  and 
bite,  and  make  a  model  with  tail  to  articulate. 
Shellac  the  model. 

Making  of  crowrn 

Use  special  high-fusing  porcelain,  and  mix  first  the  body 
porcelain  (with  water)  to  a  putty-like  consistency,  and  pack 
it  into  the  space  on  the  model,  articulate  and  carve  the  out- 
side. Disarticulate  and  carve  the  inside  roughly.  After  it 
has  dried,  remove  it,  and  biscuit  it  in  an  electric  furnace. 

The  crown  has  now  the  consistency  of  soft  chalk,  and  can 
be  carved  easily  to  receive  the  desired  shape.  However,  it 
should  be  left  long  enough  to  allow  for  shrinking  in  the  final 
baking.  A  hole  is  drilled  with  a  round  bur  to  receive  the 
post.     The  body  gives  the  color  of  the  neck  of  the  crown. 

NoM'  add  the  enamel  porcelain  very  thick  at  the  cutting  edge 
and  at  the  sides,  thinner  at  the  labial  or  buccal  surface,  and 
little  at  the  neck ;  dry  carefully,  and  bake  up  to  the  given  degree 
to  get  the  desired  glaze.  Such  a  crown  is  very  easily  fitted  in 
the  mouth  and  needs  very  little  grinding.  The  principle  of 
fitting  is  the  same  as  for  the  stock  crown. 

STOCK  CROWNS 
Crown  III. 

Post  croAvns  if  properly  selected  and  fitted  give  very  good 
and  satisfactory  results. 

Selection  of  teeth 

Take  impression  and  bite,  also  shade.  Make  model  and 
select  a  suitable  crown,  one  that  is  of  good  color  and  will 
cover  the  base  of  the  root.  The  crown  should  be  sufficiently 
long  to  permit  of  some  grinding,  and  also  tvide  enough 
to  liave  a  firm  approximal  contact  with  the  adjoining  teeth. 
If  a  crown  after  being  ground  is  too  short,  too  narrow,  or  if 
it  does  not  cover  the  entire  part  of  the  root,  this  can  easily  be 


SINGLE   CROiVNS 


83 


remedied  b^'  bakiiij;  some  porcelain  on.  Porcelain,  as  well  as 
mineral  stains,  can  be  nsed  to  advantage  to  change  the 
shape,  color  and  effect  of  a  crown.  Small  details  of  the  adjoin- 
ing teeth  can  be  imitated.  Staining  tlie  cutting  edge  and  the 
neck  to  give  a  natural  appearance  is  a  common  need  and  should 
be  more  practiced. 

METHOD   A:    WITH    ROOT   FILES 
Root  preparation 

Reduce  the  root  to  the  level  of  gum  margin  with  fissure 
burs,  root  facer  and  stones. 

Select  a  root  file  of  suitable  size,  as  wide  as  the  space  will 
allow,  and  file  the  root  end  below  the  gum  margin,  filing  in 
labio-palatal  direction.      (Figure  68.) 


Fig.  68.     File  methods  for  root  preparation. 


It  is  important  to  keep  the  file  in  the  centre  of  the  root  and 
not  file  to  one  side.  To  accomplish  this,  it  is  of  importance 
that  the  operator  take  a  good  position  by  the  chair.  Figure  69 
shows  the  position  for  filing  those  roots  which  are  the  hardest 
to  reach  with  a  root  file. 

Fitting  of   post  into  canal 

Open  and  enlarge  the  root  canal  first  with  Kerr  broaches, 
then  follow  tliis  up  with  Gates  Glidden  canal  drills,  if  necessary. 

Fill  the  apex  of  the  canal  so  that  it  is  sealed  tightly. 

Enlarge  the  upper  part  of  the  canal  with  a  Davis  root 
reamer. 

Use  a  post  corresponding  in  size  to  that  of  the  reamer. 


Fig.   69A.     Position   of   operator   filing   a    left   upper   bicuspid    root. 


Fig.  69B.     A  lower  incisor  root. 


SINGLE   CROWNS 


85 


If  the  jjost  is  not  in  the  ri«j;lit  liiK;  to  iit  into  the  slot  of 
the  crown,  use  an  offset  centre  post.  Be  sure  to  have  a  post 
large  enongh  to  till  the  canal,  leaving  no  play.      (Figure  73. j 

Grinding   of   crown 

Select  a  detached  post  crown  of  suitable  color,  one  that 
will  cover  the  root  end  and  is  sufficiently  long  to  permit  of 
some  grinding  and  Avide  enough  to  have  firm  approximal 
contact. 

Eough  grind  the  porcelain  crown  to  get  the  right  labio- 
lingual  and  mesio-distal  position. 

To  get  a  perfect  joint,  grind  the  crown  to  a  groove  filed  in  a 
toothbrush  handle  with  a  file  of  the  same  size  as  the  one  used 
in  preparing  the  root  end.  (Figure  71.)  This  can  be  done 
Avith  a  dental  lathe  stone. 

When  a  perfect  joint  is  obtained,  grind  off  any  edge  of  the 
crown  that  may  overhang  the  root  end  with  the  aid  of  gutta- 
percha. This  remaining  gutta-percha  also  prevents  the  cement 
from  washing  out  between  the  joint  of  crown  and  root.  The 
thinner  the  gutta-percha  is  pressed  Avlien  forced  into  place,  the 
better  the  result.  This  thin  layer  of  gutta-percha  undergoes  in 
the  mouth  a  hardening  process,  becomes  in  years  as  a  fibrous 
mass,  and  will  not  deteriorate. 

Fitting  of  gutta-percha  base 

Take  a  piece  of  pink  base  plate  gutta-percha  and  cut  it 
approximatelv  to  the  size  of  the  base  of  the  crown.      (Figure 

70.) 


12  3. 

Fig.  70.     Detached  post  crown  with  gutta-percha  washer. 

Punch  a  large  hole  in  the  centre,  now  moisten  base  of  the 
crown  with  chloro-percha,  warm  the  piece  of  gutta-percha  and 
seal  it  to  the  base  of  the  crown  by  pressing  moistened  finger 


CROWNS  AND   BRIDGES 


against  it.  (Figure  TO;  1,  2.)  Now  heat  over  the  flame,  and 
press  the  crown  over  the  root  with  the  post  in  position.  Let  it 
cool,  and  then  remove  crown.  The  gutta-percha  on  the  crown 
now  shows  the  outline  of  the  root.  Trim  the  gutta-percha  Avith 
a  hot  knife,  and  grind  the  crown  to  the  outline  of  the  root  with 
a  stone  running  from  the  gutta-percha  base  toward  the  crown. 
(^  Figure  70;  4,  5.)  The  outline  of  the  crown  now  fits  the  out- 
line of  the  root  exactly.  The  gutta-percha  has  been  thinned 
out  by  pressing  on  to  the  root  and  this  thin  layer  is  left  on  the 
crown  and  will  prevent  the  dissolving  of  the  cement. 

When  post  and  crown  are  both  fitted,  dry  all  parts  well, 
cement  the  post  into  the  crown  and  to  the  root  with  one  mix 
of  cement,  leaving  the  gutta-percha  in  place  between  crown  and 
root  end. 

METHOD   B:    WITH    ROOT   FACER,  AND   STONES 

Root  preparation 

Keduce  the  root  to  the  level  of  the  gum  margin  with  a  fis- 
sure bur  or  stones  or  both.  Then  cut  the  labial  and  palatal 
portion  of  the  root  with  Roach  root  facer,  till  they  extend  under 


Fig.  71.     Showing  a  root  file,  also  a  toothbrush   handle  with   root-file  grooves. 
A  tooth  has  been  fitted  to  groove  No.  3. 

the  gum.  This  will  leave  the  top  of  the  root  in  the  shape  of 
an  obtuse  angle  seen  labro-palatally,  with  the  longer  side  of 
the  angle  on  the  palatal  side.      ( Figure  72. ) 


Fitting  post  into  canal 

Open  the  root  canal  with  a  Kerr  broach  and  Gates  Glidden 
canal  drill,  if  necessary. 

Fill  the  apex  of  the  canal  so  that  it  is  sealed  tightly. 


SINGLE   CROtVNS 


87 


Fig.   72.     Root   preparation   for   detached   post   crown. 

Enlarge  the  upper  part  of  the  canal  with  Davis  root  reamer. 

Use  a  post  corresponding  in  size  to  that  of  tlie  reamer. 
There  are  posts  of  different  metals  ami  sizes,  straight  and  off- 
set centre  posts,  tlie  latter  for  crowns  wlicre  the  root  canal  and 
the  hole  in  the  crown  do  not  line  np   (Fignre  73),  split  posts 


Fig.  73.     Showing  a  straight  and  an  offset  centre  post,  such  as  used  in  detached 

post  crowns. 

for  npper  first  bicnspids.  Platinnm  posts  may  be  enlarged  by 
casting  to  same,  or  a  strip  of  plate  or  wire  wonnd  around  the 
posts  and  soldered.  It  is  most  important  to  have  the  post  fill 
the  canal. 


Grinding  of  crown 

Grind  the  crown  to  fit  the  end  of  the  prepared  root,  using 
articulating  paper  between  crown  and  root  end  as  a  guide, 
or  use  the  gutta-percha  method  described  in  Method  A. 

Fit  the  post  and  cement  the  crown  as  described  in  Method  A. 


CROlfNS   AND    BRIDGES 


B.     PORCELAIN   CROWNS   WITH   METAL   BASE 

1.  Porcelain  baked  crown  with  platinum  base. 

2.  Porcelain  crown  with  cast  base. 

1.     PORCELAIN    BAKED    CROWN    WITH    PLATINUM    BASE 

Crown  IV. 

A  porcelain  baked  crown  can  be  constructed  from  a  facing 
or  rubber  tooth,  with  platinum  pins  soldered  and  baked  to 
platinum  cap  and  post.      (Fii>ure  74.) 


Fig.   74.     Steps   of   making   porcelain   baked   crown,    using   platinum   base. 

Root  preparation 

Prepare  root  as  for  Crown  III,  A  or  B. 

Fitting  of  post  into  canal  and  making  of  cap 

Fit  an  iridio-platinum  post  into  root  canal  of  same  size  as 
root  reamer  used. 

Remove  post  and  fit  a  cap  of  platinum  plate  (32-gauge) 
over  ground  surface  of  root,  as  following: 

Punch  a  hole  in  the  platinum  plate  over  the  opening  of  the 
root  canal,  and  push  the  previously  fitted  post  through  the  plate 
into  position;  leave  the  post  projecting  over  the  plate,  withdraw 
and  catch  with  platinum  solder  or  24-karat  gold  plate  or  foil. 
Eeplace  to  root  and  burnish  the  plate  well  over  the  edges  of  the 
root,  holding  it  in  place  with  a  suitable  instrument,  and  press- 
ing the  metal  with  a  shoe-shaped  gold  plugger  on  to  the  root, 
trimming  and  conforming  the  cap  until  perfectly  seated. 


SINGLE   CROl^NH  89 


Making  of   crown 

Take  a  wax  ])ite  and  plaster  impression  with  tbe  cap  and 
post  in  ]iositioii.  T'ast  the  iiiii)i'essi()n  with  cap  and  post,  usiii^ 
plaster  and  I'ortland,  or  other  suitable  investment. 

Grind  a  facing  to  the  articulated  model. 

Bend  the  pins  of  the  facing  to  the  platinum  post. 

Wax  the  facing  to  the  cap  and  post  and  invest. 

Boil  the  wax  out  and  heat  it  carefully. 

Solder  tiie  facing  and  tlie  cap  to  the  post  witli  platiiiuiu 
solder  or  pure  gold  plate. 

When  cool,  remove  the  jjlaster  and  fill  in  with  medium  or 
high  fusing  porcelain  the  back  of  the  soldered  facing  and 
cap. 

Keep  tapping  to  bring  tlie  iiioisture  to  the  surface  until 
perfectly  dry.  Set  the  crown  on  a  broken  clay  pipe-stem  and 
bako. 

Bake  it  with  a  slow  heat  up  to  fusing  point  and  again  cool 
down  slowly. 

Add  more  porcelain  if  necessary,  and  bake  again  until 
the  required  shape  is  olttained. 

Cementing   of  Crown 

Cement  to  the  root  in  ordinary  manner. 

2.     PORCELAIN   GROWN  WITH   CAST  BASE 

If  the  root  is  decayed  under  the  gum  line,  and  a  band  is 
impossible  or  undesirable,  a  cast  base  will  often  meet  the  re- 
quirements to  obtain  good  results  by  the  direct  or  indirect 
methods. 

Direct  Method.     (Figure  75.) 

Root  preparation 

Remove  all  decay  from  the  root  and  reduce  it  with  burs, 
stones  and  root  facers,  till  it  extends  slightly  under  the  gum 
margin. 

Open  the  canal  with  a  Kerr  broach  and  Gates  Glidden  canal 
drill  and  enlarge  it  with  a  root  reamer. 


90 


CROWNS   AND   BRIDGES 


Fitting  of  post  and  making  of  crown 

Fit  an  iridio-platimim  post  as  liii»li  toward  the  apex  as 
possible. 

Eough  grind  a  detachable  post  crown  of  suitable  size,  and 
color,  so  that  it  will  fit  close  to  the  labial  portion  of  root  end, 
leaving  a  V-shaped  space  between  crown  and  root  end  on  the 
palatal  side.      (Figure  75.) 


Fig.  75.     Porcelain  crown  with  cast  base.     Direct  Method. 


Vaseline  the  base  of  the  porcelain  crown. 

Warm  the  post  and  form  inlay  wax  around  it. 

While  wax  is  soft  press  the  post  and  wax  into  the  canal 
and  press  the  vaselined  porcelain  crown  into  position. 

With  a  warmed  instrument  trim  the  excess  wax  so  that  it 
will  be  flush  with  the  sides  of  the  root  and  crown;  when  the 
wax  is  chilled  carefully  remove  from  the  root,  first  the  crown, 
and  then  the  post  with  wax  attached  to  it. 

Attach  sprue  wire  to  the  thick  palatal  part  of  the  wax. 

Invest  and  cast  with  22-karat  gold  to  the  post. 

Kemove  any  imperfection  from  casting  and  fit  crown  to 
casting  and  to  root  end. 

Cement  porcelain  crown  to  base  and  polish. 

Cementing   of  Crown 

Cement  then  the  crown  to  the  root  in  the  usual  manner. 

Indirect  Method.      (Figure  76.) 

Root  preparation   and    fitting   of   post 

Prepare  root  as  for  direct  method. 


SINGLE   CROf^NS 


91 


Fitting  of  post 

Fit  post  as  for  direct  method,  tlien  cover  the  fitted  post 
with  a  thin  film  of  wax  or  paralfiiie,  and  i>ress  it  into  the  root 
canal. 

Impression 

Select  a  copper  hand  of  suitahh'  size  and  fit  it  over  the  pre- 
pared root.  Take  an  impression  of  the  root  by  forcinj^  a  Kerr 
modelling-  componnd  stick,  the  end  of  whicli  has  he<^n  softened 
into  the  band. 


Fig.  76.     Porcelain  crown  with  cast  base.     Indirect  method. 

Take  an  impression  of  the  adjoining  teeth,  and  a  bite  to 
make  an  articulated  model. 

Trim  and  shape  the  die  cone-shape  and  place  it  into  the 
impression,  same  as  placing  a  crown  abutment  back  into  the  im- 
pression, then  make  an  articulated  model,  from  which  the  die 
can  be  removed. 

Making  of  crown 

Select  a  porcelain  crown  of  suitable  color.  Shape  it  to  fit 
at  the  labial  or  buccal  part  of  the  neck,  also  to  be  in  contact 


92  CROWNS  AND   BRIDGES 

with  the  adjoining  teeth,  and  to  occlude  properly.  Grind  the 
porcelain  crown  at  the  palatal  side  so  that  there  is  a  large  V- 
shaped  space  between  the  root  and  the  base  of  the  crown. 

Eemove  the  post  from  the  amalgam  die,  vaseline  the  die  as 
well  as  the  base  of  the  porcelain  crown. 

Take  some  inlay  wax  which  has  been  heated  previously,  and 
stick  the  post  to  same,  then  place  it  over  the  die,  pressing  the 
porcelain  crown  in  position  while  the  wax  is  soft. 

Let  the  wax  cool  and  remove  the  die  and  crown  from  the 
model.  Take  a  warmed  instrument  and  trim  the  wax  flush 
with  the  model  and  the  crown. 

Place  a  sprue  wire  into  the  lingual  part  of  the  wax  where  it 
is  thickest.  Eemove  the  porcelain  crown  and  then  draw  the 
wax  with  the  post  from  the  die. 

Invest  and  continue  as  for  the  direct  method. 

G.     BANDED   CROWNS 

These  are  a  step  removed  from  the  ideal,  as  a  band,  even  if 
fitted  very  accurately,  is  irritating  to  the  gum  and  therefore 
more  or  less  objectionable.  For  bridge  abutments  this  is,  how- 
ever, very  often  required  to  get  strength,  and  it  has  its  obvious 
advantages  for  weak  roots.  Platinum  is  the  ideal  metal  for 
root  bands  and  caps. 

I.    Base  for  Banded  Crowns 

Direct  Method 

1.  Soldered  caps. 

2.  Burnished  caps. 

Indirect  Method 

3.  Swaged  caps. 

n.    Supplies  for  Banded  Crowns 

A.  Banded  crown  with  facing. 

B.  Banded  crown  with  detached  post  crown. 

C.  Banded  crown  with  Goslee  tooth. 

D.  Banded  crown  with  Steele  tooth. 


SINGLE   CROli'NS  93 


I.    Base  for  Banded  Crowns 
Direct  Method 

1.     SOLDERED   CAP 
Root  preparation 

Remove  all  decay  from  the  root.  Grind  the  labial  portion 
down  below  the  gum  margin  while  the  palatal  portion  may  be 
left  longer. 

Cut  the  sides  of  the  root  parallel,  removing  all  enamel  by  the 
use  of  enamel  cleavers,  knife  edge  stones,  Evans"  tissure 
burs,  or  all  combined. 

Oj^en  the  root  canal  Avith  Kerr  broaches  and  Gates  Glidden 
drills  and  enlarge  with  Davis  root  reamer. 

Making  of  cap 

Measure  circumference  of  the  root  below  the  gum  margin 
with  a  wire  in  dentimeter.  (Figure  77.)  Use  platinum  plate 
or  cut  a  strip  of  22-karat  30-gauge  gold  plate  with  sides  par- 
allel of  the  length  of  the  wire.  File  the  ends  so  that  they  form 
a  perfect  joint  when  bent  to  a  band.      (Figure  77, ) 


Fig.  77.       Steps   for  making  of  band  for   soldered  cap. 

Bind  around  this  band  an  iron  binding  wire  to  hold  the 
joint  together  while  soldering.  Put  wet  flux  outside  of  the 
joint  and  a  small  piece  of  22-karat  solder  on  inside.  Hold  it  in 
the  flame  and  flow  the  solder,  uniting  the  joint.  Fit  the  band 
on  root,  trimming  the  cervical  edge  parallel  to  the  margin  of 
gum  and  filing  it  to  a  bevelled  edge.  See  that  it  extends 
slightly  under  the  gum  margin. 


94 


CROWNS   AND   BRIDGES 


Trim  the  top  of  the  band  so  that  it  is  flush  with  the  top  of 
the  root. 

Burnish  a  piece  of  34-gange  22-karat  silver  alloy  gold  plate 
over  the  top  of  the  root  and  band.  Remove  band  and  fit  the 
burnished  piece  to  place,  soldering  it  with  22-karat  solder. 
(Figure   78.)       Trim    the    overhanging    edges.       Cut   a    hole 


Fig.  78.     Fitting  of  top  to  band  and  soldering  post. 

through  the  top,  opposite  the  root  canal,  with  Dr.  Hovestadt's 
special    punch    (Fig-ure    79)    and  burnish  well  into  the  root 


Fig.  79.     Dr.  Hovestadt's  special  plate  punch. 

canal.  Push  the  iridio-platinum  post  through  the  cap  into 
the  root  canal,  allowing  a  short  piece  of  the  post  to  extend  from 
cap.     (Figure  80.) 


[2i 


a    uvn 


V  v  ■ — ■ — '^- 

Fig.  80.     Showing  the  use  of  the  plate  punch. 


SINGLE   CROfi'NS  95 


Take  a  small  plaster  impression  to  secure  the  relation  of 
fehe  cap  and  post. 

Remove  cap  and  post  and  fit  into  i)lace  in  the  impression. 
Make  small  model  of  impression  material.  When  snfficiently 
hard  break  the  impression  away  and  solder  with  22-karat  sol- 
der. Sticky  wax  or  Kerr  impression  sticks  may  be  used  in- 
stead of  plaster  im])ression  l)y  lieatin*;  the  end  of  the  stick  and 
pressing  it  against  the  extending  post  and  cap.  Chill  and 
withdraw.     Invest  and  solder  as  above.      (Figure  78.) 

Flow  solder  first  on  the  post  then  draw  it  to  the  cap ;  other- 
wise it  would  flow  over  the  cap  only.  Platinum  plate  and 
posts  for  all  kinds  of  hases  in  croirmrorl-  cannot  he  surpassed 
and  (live  the  best  satisfaction. 

2.     BURNISHED    CAP    ^Crown  VII) 

Root  preparation 

Cut  the  root  level  to  the  gum  line,  then  bevel  all  sides  of 
it  below  the  gum,  leaving  the  centre  around  the  root  canal 
opening  high.      (Figure  74.) 

Making  of  cap 

These  caps  can  be  made  of  platinum  plate  34  gauge,  or 
32-gauge  pure  gold  plate. 

Take  a  piece  of  sufficient  size  to  cover  the  top  of  the  root 
and  punch  a  hole  through  its  centre  with  special  punch.  (Fig- 
ure 81.)        Place  this  over  the  root,  and  push  a  previously 


Fig.  81.     Hand-burnished  top  with  post.     (Finished  crown.) 

prepared  good  fitting  post  through  the  hole  into  the  root  canal. 
Flow  a  little  sticky  Avax  connecting  post  and  plate  (small  cot- 
ton pellets  saturated  with  sticky  wax  are  very  practical  for 
tliis  purpose)  and  withdraw  from  the  root.  Invest  and 
solder  the  post  to  the  plate.  To  determine  the  exact  out- 
line  of   tlie  root   and   to   trim   the   plate   or   cap  accordingly, 


96  CROWNS  AND   BRIDGES 

take  a  piece  of  temporary  stoj)ping,  press  it  flat  and  punch  a 
hole  through  the  middle  and  lay  this  over  the  back  of  the 
plate.  Heat  all  and  press  it  on  the  root,  chill  and  withdraw 
it.  Trim  the  plate  according  to  the  outline  of  root  on  the 
temporary  stopping.  Then  remove  the  temporary  stopping 
and  return  the  cap  to  the  root,  holding  the  cap  in  position  with 
a  suitable  instrument  with  the  left  hand,  and  with  the  right 
hand  form  the  plate  to  the  shape  of  the  root  by  working  with  a 
cerated  instrument  from  the  post  towards  the  periphery.  A 
shoe-shaped  gold  plugger  is  ver^^  good  for  this  purpose.  Hand 
or  automatic  mallets  are  also  very  practical  to  drive  the  plate 
to  place.  The  old  hand  mallet  and  shoe  plugger  is,  however, 
preferable  to  any  other  method  when  fitting  a  platinum  plate 
to  the  root.  Hold  the  plate  in  position  with  the  left  hand,  the 
right  holding  the  long  plugger;  the  assistant  is  to  deliver 
two  blows  at  each  position  of  the  shoe-point.  A  cerated  instru- 
ment lays  the  metal  down  smoother  and  quicker  than  a  smooth 
flat  instrument  or  burnisher,  which  will  thin  out  and  wrinkle 
the  metal.  Kemove  the  burnished  cap  and  trim  the  edges 
smooth. 

Indirect  Method 

3.     SWAGED    CAPS 
Root  preparation 

Prepare  the  root,  removing  all  decay,  and  trim  it  slightly 
below  the  gum  margin,  leaving  its  centre  high.      (Figure  82.) 


Fig.  82.     Steps  showing  the  making  of   swaged   root  caps    (or  coping). 


SINGLE   ClWI^yNS  97 


Making  of  cap 

Fit  an  iridio-platinuin  post  into  tlio  root  canal  as  ]iijj;li 
toAvard  apex  of  the  root  as  possible. 

Kemove  post  and  fit  a  copper  band  loosely  around  root. 

Shape  a  Kerr  impression  compound  stick  to  fit  the  inside 
of  the  band;  soften  the  end  of  the  stick  and  press  it  into  the 
copper  band  on  the  root.      (Figure  82.) 

Chill  and  remove  the  compound  and  band  and  cast  a  plaster 
model  of  the  root  end. 

After  the  plaster  has  hardened,  remove  the  compound, 
lengthen  the  outline  of  the  root  end  on  ])]aster  model  by  trim- 
ming the  plaster. 

Powder  and  press  this  plaster  model  of  the  root  into  soft 
moldine,  pour  Melotte's  metal  into  tlic  impression  thus  gained. 
(Figure  82.) 

Swage  on  tliis  metal  die  a  32-  or  34-gauge  platinum  plate  to 
form  a  cap  or  coping.      (Figure  82.) 

Trim  and  fit  the  coping  to  the  root  in  mouth. 

Eemove  and  punch  hole  through  coping  with  Dr.  Hove- 
stadt's  special  punch. 

Place  the  coping  back  to  the  root  and  force  the  fitted  post 
through  the  hole  in  the  coping  into  the  root  canal.    (Figure  82. ) 

Dry  the  coping  and  the  end  of  the  post  and  place  cotton 
pellet  saturated  with  sticky  wax  over  them  to  secure  the  rela- 
tions of  the  two. 

Withdraw  the  coping  and  post  carefully  from  the  root  and 
invest. 

Solder  the  post  to  the  coping  with  a  small  piece  of  platinum 
solder  or  pure  gold.  Boil  in  acid.  The  swaged  cap  or  coping 
is  now  ready  to  receive  its  mount. 

II.    Supplies  for  Banded  Crowns 

A.     BANDED   CROWN    WITH    FACING    (Richmond) 
Crown  VIa,  Crown  VIIa,   Crown  VIIIa 
Making  of  model 

After  the  cap  and  post  are  made,  by  any  of  the  Methods  VI, 
VII,  VIII,  place  the  cap  on  the  root.  Take  a  wax  bite  and  plas- 
ter impression  and  stick  the  cap  and  post  in  place  into  the  im- 
pression. 

Make  an  articulated  model,  using  an  anatomical  crown  and 
bridge  articulator. 


98  CROWNS  AND   BRIDGES 

Making  of  crown 

Grind  a  suitable  facing  to  fit  the  cap  and  bite,  allowing  a 
space  of  24:  gange  between  it  and  the  occlnding  teeth.  Bevel  the 
back  of  the  cntting  edge  of  the  facing. 

Make  double  gold  backing  and  attach  them  to  the  facing. 
(Figures  62,  G3. ) 

^Vax  facing  to  cap  and  post  and  invest. 

Boil  the  wax  out  and  heat  it  slowly.  Solder  with  IS-  or  20- 
karat  solder.  When  cool,  remove  tlie  investment,  boil  in  acid 
and  polish.      (See  Figure  83.) 


Fig.  83.     Banded  crown  with  facing. 

B.     BANDED   DETACHED    POST   CROWN 
Crown  VIb,  Crown  VIIb,   Crown  VIIIb 
Making  of  model 

Fit  a  cap  after  Methods  VI,  VII  or  VIII,  but  let  the  post 
extend  above  cap  far  enough  to  retain  a  detachable  post  crown. 
Take  a  bite  and  impression  with  cap  and  post  in  place. 
Make  an  articulated  model. 

Grinding  of  crown  to  cap  and  post 

Select  a  proper  sized  detached  post  crown.     Eough  grind 
the  crown  as  nearlj^  perfect  to  the  gold  cap  as  possible,  then  fit 


Fig.  84.     Soldered  cap  with  detached  post  crown. 


SINGLE   CROONS 


99 


it  accurately  In  riibbiii;^  the  <4r(>iiii<l  hasc  of  the  porcelain 
crown  on  tlie  gold  cap;  a  black  mark  simihii-  to  a  carbon  paper 
mark  will  be  found  where  the  jwrcelain  needs  more*  grinding. 
Eepeat  this  nntil  the  Avliole  surface  shows  the  mark  from  the 
metal  surface.     Also  see  that  the  bite  is  ground  correctly. 

It  is  advisable  to  try  the  crown  at  this  stage  to  verify  it. 

Cement  the  crown  on  the  cap  and  post,  polish  and  set. 
(Figure  84.) 

Swaged  box  for  crown 

Another  method  of  fitting  a  crown  to  the  cap  and  post  is  to 
cut  off  the  extending  post  flush  with  the  cap,  make  a  box  with 
post  for  the  crown,  and  solder  the  box  to  the  root  cap  and  post. 
Have  a  V-shaped  si)ace  towards  the  jnilatal  side  of  the  crown, 
and  bevel  the  back  and  sides  of  the  crown  to  fit  close  in  front 
only  to  the  cap. 

Swage  a  35-gauge  24-karat  gold  box  to  crown  (Figure  85), 
and  solder  a  post  through  the  box  to  fit  the  slot  of  the  crown. 


Fig.  85.     Swaged  cap  and  swaged  box  with  detached  post  crown. 


Wax  the  box  into  place,  remove  the  crown  and  paint  the 
inside  of  the  box  with  anti-flux. 
Invest  and  solder. 
Boil  in  acid  stone  and  polish. 
Cement  crown  into  the  box. 


100  CROW  1:^8   AND   BRIDGES 

C.     BANDED   CROWN   WITH    GOSLEE;  TOOTH 
Crown  Vic,  Crown  VIIc,  Crown  VIIIc 
Making  of  model 

Make  cap  VI,  VII,  or  VIII. 

Take  impression  with  cap  in  place,  and  make  model  as  in 
B  above. 

Backing  of  Goslee  tooth 

When  properly  ground,  mount  the  Goslee  tooth  into  soft- 
ened modelling  compound  in  the  swaging  ring,  leaving  that 
part  over  which  the  box  is  to  be  swaged,  exposed.  (Figure 
139D.) 

Swage  a  box  of  35-gauge  24-karat  gold. 

Trim  the  overhanging  edges  of  the  gold  away. 

Punch  a  hole  in  the  gold  opposite  the  slot  in  the  Goslee 
tooth. 

Fit  a  suitable-sized  iridio-platiuum  post  through  gold  back- 
ing into  the  slot. 

Stick  the  box  and  post  together  with  sticky  wax. 

Withdraw  the  tooth. 

Paint  the  inside  of  the  box  with  anti-flux,  invest  and  solder 
with  22-karat  solder. 

Note. — It  is  sometimes  advisable  to  reinforce  the  gold  box 
by  soldering  a  piece  of  20-gauge  platinized  gold  or  iridio-plati- 
num  wire  around  the  palatal  rim  of  the  box  to  prevent  the  box 
from  changing  shape  while  soldering.      (Figure  139H.) 

Making  of  crown 

Wax  the  box  with  tooth  to  the  cap  on  the  model,  remove 
tooth  and  invest. 

Solder  the  box  to  the  cap. 

Fit  and  cement  the  tooth  into  the  box. 

Polish  and  cement  onto  the  root.      (Figure  86.) 


Fig.   86.     Banded    crown   with    Goslee   tooth. 


SINGLE   CROWNS  101 


D.     BANDED   GROWN    WITH    STEELE   TOOTH 
Crown  VId,   Grown  VIId,  Crown  VIIId 
Making  of  model 

As  for  V. 

Backing  Steele  tooth 

Grind  Steele  tooth  to  fit  the  cap  and  bite.      (Figure  87A.) 
Fit  the  Steele  backing  to  the  tooth,  cutting  away  any  over- 
hanging edges,  except  at  the  incising  edge,  leave  that  longer 
than  the  facing,  wax,  invest  and  solder.      (Figure  87  B  and  C.) 


ABC 

Fig.  87.     Banded   crowns  with   Steele  facings. 

When  Steele  posteriors  are  used  it  is  necessary  after  grind- 
ing the  tooth  to  fit  the  cap  and  bite,  to  burnish  a  piece  of  35- 
gauge  24-karat  gold  over  that  part  of  the  tooth  which  is  not 
covered,  having  it  extend  slightly  under  the  Steele  backing. 
Solder  the  extended  piece  in  open  flame  as  Figure  132, 
or  wax  the  burnished  piece  to  the  Steele  backing  with 
sticky  wax.  Remove  it  from  the  tooth.  Paint  the  inside  of 
the  backing  with  Steele  anti-flux.  Invest  and  solder  the  two 
pieces  together. 

Eeplace  backing  on  tooth  and  see  that  it  fits.  (Figures 
132  and  131. )  To  make  full  box  for  the  Steele  posteriors,  see 
Figure  131. 

Making  of  crown 

Wax  the  backing  to  the  cap  with  sticky  wax. 

Remove  Steele  tooth  and  paint  the  inside  of  backing  with 
Steele  anti-flux.  (Figures  127  and  128.)  Invest  in  a  small 
amount  of  investment. 

Solder  the  backing  or  box  to  the  base  with  18-  or  20-karat 
solder,  restoring  the  natural  tooth  form  as  much  as  possible. 

Cement  the  porcelain  to  the  metal,  finish  and  polish.  (Fig- 
ure 87.) 


102 


CROWNS  AND   BRIDGES 


D.    ALL   METAL  CROWNS 

These  crowns  are  the  least  desirable  ones,  as  they  have  not 
only  the  disadvantage  of  extending  nnder  the  gum  in  most 
cases,  but  also  are  not  esthetic.  If  they  do  not  serve  for  bridge 
abutments,  they  can  be  avoided  almost  entirely.  Gold  inlays 
with  posts,  porcelain  crowns  with  metal  bases,  and  banded  post 
crowns  can  frequently  be  used  instead.  In  very  badly  decayed 
vital  or  split  teeth,  and  in  the  back  of  the  mouth  they,  however, 
frequently  find  their  place.  Some  of  the  different  types  of  all- 
metal  crowns  are : 


4. 
5. 


Open-faced  crowns,  glove  fit. 
Open-faced  crowns,  other  methods. 
Two-piece  crown. 

(a)  With   swaged   cusps. 

(b)  With  cast  cusps. 
Seamless  pressed  crown. 
Seamless  swaged  crown. 


1.     OPEN-FACED   CROWN,    GLOVE    FIT    (Crown  IX) 

The  use  of  open-faced  crowns  as  bridge  abutments  is  of 
great  value  in  some  cases,  especially  on  the  lower  front  teeth. 
(Figure  7.) 

Preparing  of  tooth 

Remove  all  contour  on  the  back  as  well  as  on  the  sides  of 
the  tooth  to  be  crowned,  being  careful  not  to  remove  the  enamel 
from  the  labial  surface.      (Figures  88A  and  B.) 


Fig. 


B  C 

Steps    for   seamless   open-face   crown    (glove   fit). 


SINGLE    CROH'SS 


103 


Grind  tlie  occliidiiij^  portion  of  ;in  upper  incisor,  for  an  open- 
face  crown,  so  that  a  space  e(jnal  lo  lU-uaii^c  is  left  hetwceii  it 
and  the  occluding  tooth  or  teetli. 

Do  not  shorten  the  labial  part  of  the  cntting  edge  of  a  lower 
incisor,  but  bevel  tlie  lingual  side;  this  will  decrease  the  show- 
ing of  gold  and  also  prevent  the  crown  from  sliding  do^^  ii  on 
the  tooth. 

Measnre  the  circumference  of  tooth  at  the  gum  margin  with 
a  wire  placed  in  the  dentimeter.      (Figure  90A. ) 

Making  of  model 

Take  a  plaster  impression  of  the  pre])ared  tooth  and  pour 
into  this  fusible  metal,  plunging  a  In-oken  cwcavator  into  il. 
before  it  hardens.      (Figure  89.) 


Fig.   89.     Die    with   handle.     Dotted   line   at   neck   shows    overhang,    which    has 

been  filed  away. 


104 


CROIFNS   AND    BRIDGES 


Withdraw  the  handle  with  the  attached  fusible  metal  tooth 
from  the  impression,  and  file  with  a  rubber  file  enough  from 
the  neck  of  the  metal  die  to  reproduce  the  shape  of  the  root, 
which  extends  under  the  gum  margin.  Leave  no  shoulder  on 
the  die.      ( Figure  89. )      Note  dotted  line. 

Making  of  crown 

Select  a  22-karat  gold  shell  of  sufficient  length,  the  circum- 
ference of  which  must  be  the  same  as  the  wire  measurement. 
(Figure  90B.)     (Compare  size  by  fitting  each  over  a  mandrel.) 


A  B  C  D  E  F 

Fig.  90.       Steps   continued   for   open-face   crown    (glove  fit). 

Anneal  the  gold  shell,  paint  the  inside  with  whiting  and 
drive  the  die  into  the  shell  gently  on  a  wooden  block.  When 
the  outline  of  the  cutting  edge  shows,  then  drive  the  sides  over 
the  metal  tooth,  using  a  small  contouring  hammer.  First  tap 
gently  and  then  with  increasing  force,  always  striking  the 
highest  points  of  the  shell,  until  it  is  finally  driven  to  a  glove 
fit  on  the  metal  tooth,  and,  if  necessary,  swage  it  in  a  small 
crown  and  bridge  swager.  Do  not  thin  out  the  gold  by  ham- 
mering unnecessarily  where  it  fits  close  to  the  die.  Support  the 
shell  on  the  die  by  the  pressure  of  the  forefinger  of  the  left 
hand,  the  dummy  liolding  the  handle  and  pressing  the  crown 
firm  against  the  finger;  this  will  prevent  the  shell  from  chang- 
ing its  position  at  the  start.  Pull  the  crown  from  metal  die 
or  boil  the  die  out  of  the  crown  in  water. 

Thoroughly  clean  the  inside  of  the  shell  so  that  none  of  the 
fusible  metal  remains.  Put  in  nitrous  acid  for  a  few  minutes, 
if  necessary. 

Anneal  and  trim  crown  to  proper  length  to  fit  the  tooth. 
When  the  crown  is  placed  on  the  tooth  in  the  mouth,  mark 
the  area  to  be  cut  out  for  the  open  face  or  window.  (Figure 
90  C.) 


SIXGLE   CROPFNS 


105 


Remove  the  crown  from  the  tootli  and  with  a  thin  metal 
saw,  cut  ont  the  marked  portion  (so-called  window. )  (Figure 
90D.) 

Put  the  crown  l)ack  on  tooth  and  burnish  it  to  place. 

Remove  again,  contour  and  reinforce  the  labial  portion  with 
20-karat  gold  plate,  using  20-  or  22-karat  solder.  (  Figure  OOE.  i 

Note. — Use  light  yellow  cement  for  setting  open-faced 
crowns.  Bicuspids  or  molar  crowns  are  constructed  as  Crown 
XII  or  XIII,  a  window  being  cut  at  the  buccal  side  to  give  a 
better  appearance.  Sometimes  such  a  window  can  be  cut  in  a 
gold  crown  if  the  buccal  side  of  the  tooth  is  decayed,  and  the 
buccal  side  then  filled  in  with  porcelain  cement  of  proper  color. 

3.     TWO-PIECE   ALL-METAL   CROWN    (Crown  XI) 
Root  preparation 

Cut  away  all  contour  from  the  tooth.  Cut  the  sides  of 
tooth  parallel  to  each  other  until  they  are  reduced  to  the  size 
of  that  part  of  the  neck  as  far  under  the  gum  as  the  crown 
is  intended  to  reach.  Grind  the  occluding  portion  of  the  tooth 
enough  to  allow  room  for  gold  cusps  with  reinforcement.  (Fig- 
ure 91.) 


A  B  CD  E 

Fig.  91.     Steps  for  two-piece  all-metal  crown,  swaged  cusps. 


106  CROWNS  AND   BRIDGES 

Fitting  band 

Measure  the  circumference  of  the  prepared  root  at  the  cer- 
vical margin  with  a  wire  in  the  dentimeter. 

Cut  the  wire  opposite  the  twist.  Cut  a  strip  of  22-karat 
30-gauge  gold  plate  the  same  length  as  the  wire.  Have  sides 
parallel  and  file  the  ends  so  that  they  form  a  perfect  joint 
when  bent  to  form  a  band.  Bend  strip  to  a  band  and  bind  it 
together  with  iron  binding  wire.  Solder  with  borax  placed 
on  the  outside,  a  small  piece  of  solder  on  the  inside  of  the  band. 
(Figure  91.) 

Stretch  the  occlusal  end  of  the  band  by  hammering  it  on 
an  anvil,  to  give  it  sufficient  contour  to  reiDlace  the  natural 
shape  of  the  tooth. 

Fit  the  band  to  the  circumference  of  the  root,  testing  the 
fit  with  a  smooth  broach.  Trim  the  cervical  border  so  that  it 
will  at  no  part  penetrate  more  than  ^V  inch  under  the  gum. 
Contour  the  upper  part  of  the  band,  so  restoring  the  contact 
points  with  the  neighboring  teeth  if  there  are  any. 

Cut  the  occlusal  end  of  the  band  flat. 

A.     WITH    SWAGED    CUSPS    (Grown  XIa) 

Making  of  the  cusps 

Take  wax  bite  and  plaster  impression  with  fitted  band  in 
position  on  the  tooth.  (Figure  94.)  See  that  the  band  in 
the  impression  is  in  its  right  place,  run  a  film  of  wax  on  the 
inside  of  the  band  and  make  articulated  models,  using  an  ana- 
tomical crown  and  bridge  articulator. 

Remove  the  wax.  Varnish  the  occluding  teeth  and  burnish 
thick  tin-foil  over  them. 

With  a  film  of  sticky  wax  attach  a  small  block  of  carving 
wax  over  the  band.  Soften  it  and  j)ress  the  occluding  teeth 
into  it.  Carve  the  cusps,  sulci  and  grooves  as  closely  resem- 
bling a  corresponding  natural  tooth  as  the  occlusion  will 
permit.      (Figure  95.) 

Leave  the  edge  of  the  band  exposed.      (Figure  91A. ) 

Take  an  impression  of  the  cusps  and  half  the  width  of  the 
band,  with  moldine.  Cast  a  Melotte's  metal  die  (Figure  91B) 
and  swage  cusps  over  it,  using  a  piece  of  22-karat  oO-gauge 
plate  gold.      (Figure  91C.)      Trim  this  to  fit  the  occlusion  and 


SINGLE   C ROMANS 


107 


tlic  (Ml.i'e  of  tlie  l);ni(l  (with  no  overlap).  (Figure  i)lC  and  D.) 
lleint'orce  the  cusps  and  solder  the  top  to  the  band  (Figure 
91E)  in  the  Bunsen  flame,  or  by  investing  and  soldering. 

Note. — If  the  crown  is  to  be  used  for  a  bridge  abut  iiieiil,  do 
not  finish  it  down,  boil  it  very  carefully  in  acid  to  remove  all 
flux  from  inside,  and  try  it  in  the  mouth. 

B.     WITH    CAST   CUSPS    (Crown  XIb) 

Prepare  the  tooth  for  this  crown  as  XI.      (Figure  Uli.j 
Cut  the  band  down  to  the  level  of  the  occluding  surface  of 

the  tooth.        Solder  a   34-gauge  i)ure   gold   ])lat('  to])  over  it. 

(Figure  93A.) 


Fig.  92.     Steps  for  two-piece  all-metal  crown,  cast  cusps. 


A  B 

Fig.  93.     Steps  continued  from  Figure  92. 

Place  it  on  tooth  and  take  a  bite  and  impression,  make  a 
model  and  mount  it  on  an  anatomical  crown  and  bridge  articu- 
lator as  described  for  Crown  XI. 

Soften  inlay  wax  and  press  it  on  the  top  of  the  band,  closing 
the  occluding  teeth  on  it. 


CROWNS   AND    BRIDGES 


Carve  cusps  as  nearly  as  possible  like  a  corresponding  natu- 
ral tooth,  restoring  contour  and  approximal  contact.  (Figure 
93B.) 

Remove  the  crown  from  the  model,  place  a  sprue  wire  in 
the  thickest  part  of  the  wax.  Invest  and  cast  with  22-karat 
gold.      (Figure  93C.) 

4.     SEAMLESS    PRESSED    CROWN   (Crown  XII) 

Preparing  of  tooth 

Prepare  tooth  as  for  Crown  XI. 

Fit  seamless  copper  band  over  the  prepared  tooth.      (Figure 

94.) 


1 

\ 

\        w 

'% 

%          \ 

ninl 

y-^ 

Fig.  94.     Taking  bite  with  copper  band  in  position. 


Fig.  95.     Crown  contoured  to  copper  band. 


SINGLE    CROONS 


109 


Take  plaster  impression  and  wax  bite. 

Make  a  model,  remove  the  copper  band,  build  out  and  carve 
the  tooth  in  wax.  (Figure  95.)  Place  a  strip  of  thin  plate 
niesially  and  distally  of  tooth. 

Take  an  impression  in  moldine  with  a  split  tray.  (Figure 
96.)      Cut  the  moldine  in  halves  with  a  knife,  open  the  tray. 


■ 

'.'.''^^I^Hn^ 

Fig.  96.     Showing   split   tray   with  moldine  to   take   impression   of   crown. 

powder  both  halves,  and  close  it  upon  the  croAvn  from  l)oth 
sides.  (Figure  97.)  Reopen  it,  withdraw  and  close.  (Figure 
98.)  Build  up  with  moldine  around  the  impression  of  the 
waxed  tooth. 

Pour  Melotte's  metal  into  the  impression. 


Fig.   97.     Split   tray   in   position. 


Fig.  98.     Tray  after   removal  and  closed. 


Fig.  99.     Aletal  die  and  shell. 


Fig.  100.    Wooden  block  showing  imprints  of 
metal  die  and  swager. 


SINGLE   CROH'NS 


111 


Trim  the  die,  file  invay  all  ov(ii'liaii<^'  at  tlie  iieek,  just  leav- 
iii.!*-  a  tliiii  outline  of  j-uui  line.  (  Fi.i'ui-e  99.)  Then  place  a 
i^old  shell  ovei-  it,  and  drive  it  iulo  a  woo(h-n  block  as  folhnv- 
inj^-: 

First  drive  the  die  into  the  wood  without  tlie  shell,  then 
paint  tlie  inside  of  shell  witli  Avhiting  to  prevent  jnetal  from 
stickinii'  to  gold. 

Then  place  the  shell  over  tlie  die,  and  gradually  shnjte  il 
with  small  contour  hammer.  Now  drive  the  die  or  shell  gently 
into  the  Avood  to  abont  tlie  de])th  of  the  shell.      (Figure  KIO). 

Place  the  SAvager  over  the  die  and  drive  it  into  the  Avood. 
(Figure  101.) 


Fig.  101.     A,  Swager;  B,  Die;  C,  Wood  block;  D,  Gold  shell. 

Take  out  the  die  and  tap  the  Avrinkles  out  gently.      (Figure 
102.  j 

Kei)eat   tlie  sAvaging  and  tapping  several  times  until  the 
shell  fits  absolutely  tight,  without  shoAving  Avrinkles. 


1 


Fig.  102.     Swaging  of  crown  over  die  into  wood  block.     Note  outline  of  cervical 
margin  of  crown  on  the  die. 


Fig.   103.     Melting  out  the  metal   from  the   crown. 


SINGLE   CROfVNS 


113 


Hold  tlie  crown  between  a  pair  of  pliers  over  the  flame  to 
melt  out  the  metal.      (Figure  103.) 

Then  quickly  drop  the  crown  into  50%  nitric  acid  and  let 
it  remain  there  for  a  few  minutes. 

Trim  the  gold  crown  to  fit  the  gum  margin,  as  shown  In- 
line on  crown.      (Figure  102.) 

Reinforce  crown   witli   solder. 

Stone  and  polish. 

This  method  has  the  advantage  that  the  crown  is  thickened 
by  the  process  instead  of  being  thinned  out  as  in  swaging 
into  a  die.      (Figure  104.) 


Fig.  104.     Finished  crown. 
5.     SEAMLESS    SWAGED    CROWN   (Bridge  method)   Crown  XIII 

Preparing  of  tooth 

As  for  Crown  XI. 

Making  of  crown 

Measure  the  circumference  of  the  prepared  tooth  at  the 
cervix  with  wire.  Select  a  copper  band  of  the  same  circum- 
ference as  wire  (by  mandrel)  and  of  sufficient  length.  Fit  it 
over  the  prepared  tooth  and  trim  the  cervical  edge  to  the  out- 
line of  the  gum. 

Cut  occlusal  end  short  enough  to  clear  the  bite. 

Approximately  contour  the  band  by  pressing  with  suitable 
instruments  against  the  adjoining  teeth.  Take  a  wax  bite  of 
the  copper  band  and  occluding  teeth,  a  plaster  imjDression 
(Figure  105),  and  mount  the  whole  on  anatomical  crown  and 
bridge  articulator  as  in  the  case  of  Crowns  XI  and  XII.  (Fig- 
ure 106.) 


114 


CROIFNS   AND   BRIDGES 


Fig.   105.     Seamless   all-metal   crown.     Bridge  method.     Impression   with  bands. 


Fig.    106.     Bands    on    articulated   model. 

With  Bridge's  carving  wax  build  suitable  cusjds  and  con- 
tour over  tlie  copper  band.      (Figure  107.) 

Remove  contoured  band  with  cusps  from  the  model,  and 
place  it  on  a  flat  piece  of  moldine  or  mudola,  having  same 
projecting  into  the  band.      (Figure  108.) 


Fig.   107.     Crowns   contoured  and   articulated. 


Fig.  108.     Ready  to  cast. 


SINGLE   CROIVNS 


115 


Place  Bridge's  eastiiijj;'  rinj»'  over  it  aixl  ])Oiii'  Avilli   fiisiltie 
metal.      (Figure  100.  j 


Fig.  109.     Casting  to  die. 

Have  the  surface  of  the  fusible  metal  flush  Avith  the 
cervical  edge  of  the  copper  band,  either  by  cutting  the  fusible 
metal  or  adding  more  v^dth  a  hot  spatula,  as  may  be  needed 
to  get  the  outline  of  the  gum.      (Figure  110.) 


Fig.  110.     Building  fusible  metal  to  edge  of  bands. 


Knock  the  fusible  metal  from  casting  ring  (Figure  111) 
and  split  it;  remove  the  copper  band  and  carving  wax.  (Fig- 
ure 112.) 

Place  the  two  halves  of  metal  back  into  the  casting  ring. 

Place  a  seamless  22-karat  gold  shell  into  the  metal  die. 


116 


CROWNS   AND   BRIDGES 


■i 


Fig.  111.     Knocking  off  metal  from  ring. 


Fig.  112.     Splitting  of  die. 


Have  the  shell  of  as  large  a  size  as  will  fit  into  the  die. 
Use  bridge  swager  using  vulcanite  rubber  instead  of  wax 
( Figure  113 ) ,  or  : 

Fill  shell  one-third  with  lead  shot  and  drive  it  gently  into 
the  metal  die,  using  a  mandrel  of  smaller  size  than  the  shell. 

Add  more  shot  and  pound  until  the  desired  contour  is 
obtained. 

Cut  the  cervical  edge  of  shell  to  the  edge  of  the  metal  die, 
so  as  to  get  the  proper  length  of  the  crown.  (Figure  114.) 
Eemove  and  cut  the  crown  to  the  proper  length  (Figure  115). 

Take  the  crown  out  of  the  die  and  by  gently  tapping  its 
sides  remove  all  lead  shot.  Boil  in  nitric  acid  to  remove  the 
lead  and  particles  of  die. 

Reinforce  the  cusps  with  solder  after  it  is  fitted.  Then 
polish. 


Fig.  113.     Pressing  of  seamless   shell. 


Fig.    114   shows   marking   of   swaged   crown   to   conform   to   cervical   margin   as 
determined   by   trial   band. 


Fig,    115    shows    the    curved    scissors    so    desirable    for    trimming    crowns    and 
bands,  also  how  to  trim  a  band  where  marked. 


118 


CROirNS   AND    BRIDGES 


6.     GOLD   CROWNS   WITH   PORCELAIN    FACING  (Crown  XIV) 
Preparing  of  root 

Prepare  root  as  for  Crown  XI,  but  cut  away  more  of  the 
buccal  side  to  allow^  for  the  facing. 

Making  of  crow^n 

Fit  the  gold  crown  in  one  of  the  usual  ways,  try  it  in  the 
mouth  and  outline  an  opening  for  the  porcelain  tooth.  (Fig- 
ure 116.) 


•  •. 

a  s  1 

1 

i 

Fig.  116.     Steps  for  crowns  with  porcelain  facing. 

Remove  the  crown  from  the  tooth  and  cut  the  window  ac- 
cording to  the  outline.  For  this  use  a  saw  or  knife-edged 
rubber  carborundum  stone. 

Select  a  thin  facing  and  bevel  the  sides  from  the  pins  toward 
edges  (Figure  116),  until  reduced  to  fit  the  window  or  opening 
in  crown.  Back  the  facing  with  36-  to  38-gauge  pure  gold,  tile 
the  gold  flush  to  edges,  and  allow  no  overhanging  of  the  backing. 

Wire  it  to  place  (Figure  116),  place  borax  and  solder  in  the 
inside  of  the  crown  and  solder  in  the  open  flame.  There  is 
little  danger  of  cracking  the  facing  if  the  crown  is  heated  and 
cooled  slowly.  It  is  well  to  hold  the  crown  with  the  facing 
towards  the  flame,  as  the  facing  requires  the  most  heat  for 
soldering. 

Finish  and  polish. 


VIII.    FIXED  BRIDGES 

The  ideal  replaceiiient  of  lost  leetli  is  l»y  I  lie  lixcd  hridj^e- 
work,  Imt  only  if  siiital)]e  (•onditi(jiis  favoi-  sticli  i'e]>la<-eineiits. 
If  the  teeth  and  roots,  wliicli  are  to  serve  as  jilmtiiiciils,  are  in 
a  healthy  condition,  or  if  they  can  be  put  in  siicli  ;i  condition 
by  treatment,  if  tlie  occlnsion  and  the  (listancc  lierwccii  the 
gnm  and  the  antagonizing-  teeth  is  of  snfticient  widtli.  then  a 
fixed  bridge  will  be  found  most  satisfactory  IihIimmI. 

A.    ABUTMENTS  FOR  FIXED  BRIDGES 

Bridge  abutments  should  be  selected  acccjrding  to  their 
practical  value  and  strength,  technical  conditions,  i)i-ophyhirtic 
and  estlu^tic  properties.  It  is  of  greatest  im])ortanf(-  to  select 
the  right  kind  of  abutments,  and  a  careful  study  should  be 
made  of  the  prevalent  conditions.  Here  at  the  start  is  the  op- 
portunity for  the  operator  to  show  his  ability  and  foresight, 
which  will  lead  to  success.  The  lasting  quality  of  a  bridge 
depends  greatly  upon  the  choice  of  the  abutments.  It  would 
be  unwise  to  use  open-faced,  staple  or  Iialf-shell  crowns  witli 
posts  in  a  mouth  with  acid  conditions,  because  these  would  not 
last  very  long,  the  cement  would  dissolve  and  the  teeth  decay 
at  the  exposed  surfaces.  In  a  close  bite  Ave  should  not  use 
Goslee  teeth,  Steele  posterior  or  Davis  croAvns,  as  they  could 
not  be  made  strong  enough.  In  pyorrhoeatic  conditions,  bands 
under  the  gums  should  be  avoided,  and  the  foremost  thought  in 
constructing  the  bridge,  should  be  the  possibility  of  propliv- 
lactic  treatment  of  the  abutments  and  the  adjoining  teeth. 
Some  of  the  bridge  abutments  have  already  been  described  in 
the  previous  chapter  on  single  crowns;  they  will  therefore  only 
be  referred  to  here,  while  abutments  which  have  not  yet  been 
spoken  of,  will  be  described  in  detail. 

INLAY  ABUTMENTS 

1.     INLAY   WITH    POSTS  AND   M.  O.  D.   INLAYS  (Abutment  I) 

Inlays  for  bridge  abutments  should  be  cast  with  platinized 
gold.     They  should  invariably  have  posts  in  the  pulp  canals 


120 


CROWNS  AND   BRIDGES 


with  the  possible  exception  of  M.  O.  D.  cavities  (mesial,  occlu- 
sial,  and  distal  cavities) . 

All  cavities  for  inlay  abutments  shonld  be  sufficiently  cut 
so  that  the  arold  extends  well  towards  the  buccal  and  lino'ual 


Fig.   117.     Tooth  preparations  for  inlay  abutments. 

surface,  this  gives  the  patient  a  chance  to  keep  the  margins 
clean.  The  cervical  margin  of  the  inlay  should  extend  below 
the  gum. 

Impression 

Inlays  can  be  made  by  the  direct,  but  preferably  by  the 
indirect  method.  In  the  latter  method  we  take  an  impression 
with  a  small  tray,  a  seamless  copper  or  aluminum  band.     Fill 


Fig.   118.     Steps   for  bridge   with   inlay  abutments. 

it  with  Kerr's  modelling  compound  (stick  form),  and  press  it 
over  the  tooth  or  place  the  ring  over  the  tooth,  pressing  the 
softened  end  of  the  modelling  compound  stick  into  it.  Let  it 
cool. 

The  wax  pattern  is  then  roughly  shaped  in  the  mouth,  by 
letting  the  patient  bite  into  it,  and  also  perform  slight  lateral 
masticating  movements.  Take  also  a  wax  bite  of  cavity,  and 
the  adjoining  teeth  in  case  an  articulated  model  is  wanted. 

For  Taggart's  wax  use  the  following  method: 


FIXED  BRIDGES  121 


Mount  the  piece>s  of  wax  on  lon^-  pins  tliat  are  stiir-k  into 
a  large  round  piece  of  cork  to  fit  the  top  of  a  water  glass.  The 
glass  is  filled  with  hot  water.  The  heat  of  the  water  may  be 
tested  by  holding  a  piece  of  wax  in  same,  and  should  not  be 
quite  as  hot  as  to  turn  the  wax  pale.  The  pieces  of  wax 
mounted  on  the  pins  of  the  cork  are  allowed  for  a  few  minutes 
in  the  liot  water,  and  may  then  be  found  just  right  to  press 
into  the  tootli  cavity  or  metal  die. 

Kerr's  blue  inlay  wax  is  commendable,  and  can  be  softened 
in  the  flame.  Good  results  can  be  obtained,  if  handled  care- 
fully. 

Making  of  die 

The  impression  in  the  seamless  band  is  invested  in  plaster 
and  when  plaster  is  hard,  filled  with  silver  and  tin  amalgam, 
carefully  packing  it  into  all  the  grooves  and  corners.  If  there 
is  a  post  in  the  inlay  this  should  be  withdrawn  with  the  impres- 
sion. Cover  the  end  of  the  post,  extending  out  of  the  impression, 
with  a  thin  film  of  wax  so  that  it  can  be  removed  from  the  amal- 
gam die  later. 

After  the  amalgam  has  hardened,  the  modelling  compound 
should  be  softened  in  moderately  warm  Avater  and  removed. 
The  die  is  now  trimmed  best  with  a  sandpaper  wheel  on  the 
lathe.  In  case  we  want  to  carve  the  wax  on  a  model,  trim 
the  distal  and  mesial  ends  of  the  die  cone-shaped,  so  as  to  be 
able  to  remove  it  from  the  model,  then  place  it  into  the  plaster 
impression  taken  for  this  purpose  from  the  mouth.  Make 
an  articulated  model  from  the  metal  die  and  bite. 

Carving  inlay 

The  wax  pattern  is  now  placed  into  the  die.  Sometimes  it 
has  to  be  slightly  warmed  first,  but  not  enough  to  lose  its  form, 
nor  press  it  out  of  shape.  After  it  gets  hard,  carve  it  with 
special  carving  knives,  reproducing  all  the  cusps,  grooves,  fis- 
sures and  sulci,  which  are  best  copied  from  a  good  selection 
of  extracted  teeth,  or  a  good  model  taken  from  a  mouth  of 
perfect  teeth.  After  carving  the  wax,  Taggart  recommends 
smoothing  the  surface  by  the  aid  of  alcohol  or  chloroform. 

Place  a  sprue  wire,  which  is  to  be  of  the  size  of  a  common 
pin    (but  a  large  one  will  do),  into  the  greatest  bulk  of  the 


122  CROirNS   AND    BRIDGES 

wax,  Eemove  the  wax  from  tlie  model  carefully,  and  with  a 
very  fine  cameFs  bair  brush  remove  all  fatty  substances  by 
painting  the  whole  surface  with  alcohol;  this  makes  it  easier 
for  the  investment  to  stick. 

Place  the  sprue  wire  on  the  sprue,  fixing  it  with  wax  if 
necessary. 

Investing 

Proceed  as  described  in  chapter  on  casting. 

Cast 

Cast  as  described  in  the  chapter  on  casting.  It  is  best  to 
use  ever}^  time  new  gold  as  it  is  seriously  affected  by  every  re- 
melting. 

B.    BANDED   CROWN  ABUTMENTS 
1.    Base  for  Banded  Abutments 

1.  soldered    cap  (Abutment  II) 

See  Crown  VI. 

2.  burnished   caps  (Abutment  III) 

See  Crown  VII. 

3.  SWAGED   CAPS  (Abutment  IV) 

See  Crown  VIII. 
II.    Supplies  for  Banded  Abutments 

A.     WITH    FACING  (Abutment  IIa,  IIIa,  IVa) 

See  Crown  VIA,  VIIA,  VIIIA. 

B.     WITH    DETACHED    POST    CROWN   (Abutment  IIb,  IIIb,   IVb) 

See  Crown  VIB,  VIIB,  VIIIB. 

C.  WITH    GOSLEE  TOOTH  (Abutment  lie,  IIIc,  IVc) 

See  Crown  VIC,  VIIC,  VIIIC. 

D.  WITH    STEELE   TOOTH   (Abutment  IId,  IIId,  IVd 

See  Crown  VID,  VIID,  VIIID. 


I'lXI'J)  BRIDGES  123 


G.     ALL   METAL   ABUTMENTS 

(Abutment  V) 

1.     HALF    GROWN    WITH    POST 

Preparing  of  tooth 

Iveiiiove  pulp  under  rubber  daiii  b}'  opening  the  to(jtli  on 
the  palatal  side,  near  cutting  edge,  so  as  to  get  in  straight  line 
with  the  root  canals,  and  (ill  the  a])ex  of  the  root  canal  care- 
fully. 

Enlarge  the  canal  and  til  an  ii'idio-])latinnni  |»ost  into  same. 


Fig.   119.     Hall   crown  with  post. 

Remove  the  post,  reduce  the  tooth  to  clear  the  bite  of  the 
opposing  teeth,  have  a  21-gauge  space  to  allow  for  gold  plate 
and  reinforcement  of  the  crown. 

Cut  awa^^  the  approximate  contour  of  the  tooth  on  the  side 
where  the  dummy  is  to  be  attached;  this  may  be  mesially,  dis- 
tally,  or  on  both  sides. 

Remove  all  contour  on  that  surface  of  tooth  to  be  covered. 

Making  of  die 

Take  plaster  impression  of  the  prepared  tooth  Avithout  the 
post. 

Remove  the  plaster  impression,  bank  both  sides  of  the  im- 
pression of  the  tooth  with  moldine,  and  flow  low  fusing  metal 
into  it. 

Pull  the  metal  from  the  impression,  and  file  the  neck  of  the 
metal  tooth  on  the  palatal  and  approximal  side,  to  reproduce 
the  shape  of  the  root  under  gum  margin,  so  as  to  allow  the 
gold  backing  to  extend  slightly  below  the  gum. 

Making  of  crown 

Swage  a  24-karat  3()-gauge  gold  backing  over  the  back  of 
tooth. 

Trim  and  fit  the  swaged  backing  to  tooth  in  the  mouth. 


124  CROM'NS   JND   BRIDGES 

Force  the  iridio-platinnm  post  through  the  backing  into 
canal  opening,  allowing  the  post  to  extend  a  little  through 
backing.  Flow  sticky  wax  over  backing  and  post,  remove 
carefully,  invest  and  solder,  or  take  a  plaster  impression. 

Kemove  backing  and  post  carefully  from  the  tooth,  place 
them  into  their  place  in  the  impression,  and  cast  a  model. 

Solder  the  post  to  the  backing  and  flow  solder,  evenly,  over 
the  palatal  surface,  but  not  on  the  mesial  and  distal  wings. 
This  is  to  allow  for  the  burnishing  into  place  at  the  time  of 
cementing.  Be  sure  to  use  a  light  yellow  cement  for  the  setting 
of  the  lialf  crowns  with  post,  to  bring  out  the  natural  color 
of  the  tooth. 

2.     STAPLE    GROWN   (Abutment  VI) 

Preparing  of  tooth 

Grind  the  occluding  portion  of  tooth  so  that  a  space  equal 
to  24  gauge  is  left  between  the  occluding  tooth  or  teeth. 

With  thin  safeside  carborundum  disc  cut  enough  contour 
from  the  mesial  and  distal  surfaces  of  the  tooth  to  allow  a  30 
gauge  gold  plate  to  pass  between  the  adjoining  tooth. 

Remove  all  contour  from  palatal  side  of  the  tooth.  Then 
cut  a  horizontal  groove  for  the  staple.  This  groove  should  be 
started  well  toward  the  cutting  edge  'of  incis.ors  and  through 
the  occlusal  fissure  in  bicuspids.  ( In  most  cases  this  groove  is 
best  started  with  a  thin  carborundum  disc.) 

For  mesial  and  distal  grooves  use  a  round  bur  (size  S.  S, 
White  1). 

The  grooves  can  be  enlarged  with  a  fissure  bur  to  18  gauge. 

Note. — Extreme  care  must  be  taken  to  have  mesial  and  dis- 
tal grooves  parallel  to  each  other  and  with  the  long  axis  of  the 
tooth. 

Fitting  staple 

Measure  the  length  of  mesial  groove  with  18-gauge  iridio- 
platinnm  wire. 

Mark  the  wire  at  point  where  mesial  and  horizontal  grooves 
meet,  and  bend  it  at  the  point  marked. 

Hold  the  wire  into  the  horizontal  groove  with  the  bent  end 
in  the  mesial  groove  and  mark  the  wire,  for  the  length  of  hori- 
zontal groove. 


FIXED  BRIDGES 


125 


Bend  at  the  mark. 

Measure  with  plain  wire  the  length  of  distal  j^roovc,  and 
mark  the  length  on  the  platinum  wire. 

Cut  the  wire  at  that  mark  and  file  the  ends  sc^uar*'. 

By  adjusting  and  bending,  fit  the  staple  accurately,  and  see 
that  it  fits  firmly. 

Making  of  crowrn 

Place  staple  into  position  and  take  a  plaster  impression  of 
the  tooth. 

Remove  the  plaster  impression  and  place  the  staple  wire 
into  the  impression. 

Flow  low  fusing  metal  into  it. 

Pull  the  metal  from  imj^ression  and  file  the  neck  of  the  metal 
tooth  to  reproduce  the  shape  of  the  root  slightly  under  the  gum 
margin.     The  staple  is  now  in  the  metal  die. 

Swage  backing  of  30-gauge  24-karat  gold  plate  over  the 
back  of  tooth  (metal  die). 

Have  the  gold  backing  cover  the  tooth,  from  cutting  edge  to 
below  the  gum  line,  and  extend  it  mesially  and  distally  be- 
yond staple  wire. 


Fig.  120.     Steps  for  making  of  staple  crowns. 


126  CROWNS  AND   BRIDGES 

Kemove  the  backing  and  leave  it  in  nitric  acid  for  a  few 
minutes.  Force  or  melt  the  staple  ont  of  the  die,  and  place  it 
in  the  groove  of  the  swaged  backing.  Catch  it  at  one  point 
with  22-karat  solder,  and  fit  the  crown  on  tooth  in  the  mouth, 
by  pressing  against  the  staple  of  crown  to  force  it  to  place ;  bur- 
nish the  whole  surface.  Kemove  and  complete  the  soldering  of 
the  staple.  Boil  in  sulphuric  acid,  trim  and  place  it  on  the 
tooth,  take  wax  bite  and  impression  for  the  bridge.  ( See  steps, 
Figure  120.) 

Note. — When  soldering  dummies  to  a  staple  crown,  flow  the 
gold  solder  well  over  the  backing,  the  palatal  surface  of  the 
staple  crown,  except  at  the  mesial  and  distal  wings,  which 
should  remain  soft  so  that  they  can  be  burnished. 

Use  light  yellow  cement  for  the  setting  of  staple  crowns,  and 
burnish  the  wings,  when  cementing,  to  get  close  adaption  on 
mesial  and  distal  parts. 

3.     OPEN-FACED    CROWN,    GLOVE    FIT  (Abutment  VII) 

See  Crown  IX. 

4.     OPEN-FACED   CROWN,    OTHER    METHOD  (Abutment  VIII) 

See  Crown  X. 

5.     TWO-PIECE   ALL-METAL  GROWN  (Abutment  IX) 

See  Crown  XIA-XIB  (swaged  and  cast  cusps). 

6.     SEAMLESS    PRESSED    CROWN  (Abutment  X) 

See  Crown  XII. 

7.     SEAMLESS   SWAGED    CROWN  (Abutment  XI) 

See  Crown  XIII. 

8.     CROWN    WITH    PORCELAIN    FACING   (Abutment  XII) 

See  Crown  XIV. 

B.     SUPPLIES  FOR   BRIDGEWORK 

There  are  different  ways  of  supplying  the  lost  teeth.  The 
best  supply  is  the  one  that  has  a  porcelain  chewing  surface,  but 
with  a  close  bite,  gold  is  advisable  to  give  the  desired  strength. 


FIXED  BRIDGES 


\21 


1.     CAST    SUPPLIES  fSupply  I) 

Make  articiilatcMl  plastoi-  models,  Avitli  abutiiieiits  iji  place, 
and  press  softened  inlay  wax  between  tliem.  (Fi<;nre  121.) 
Occdude  the  articulator  so  as  to  i-ct  ini]H-int  of  tlie  occlnding 


Fig.  121.     Model  on  articulator  for  cast  supplies. 

cusp,  the  teeth  occlnding  opposite.  Make  also  masticating  mo- 
tions. When  cold  carve  the  wax  as  nearly  like  the  cusps  of 
natural  teeth  as  occlusion  will  i)ermit. 

Slant  the  wax  on  the  under  side,  so  as  to  form  a  bevel 
toward  center,  or  a  Y-shape  in  cross  section. 

Remove  wax  from  the  model,  insert  a  sprue  wire,  invest  and 
cast  with  20-karat  gold.      (Figure  122.) 

Stone  or  file  casting  and  wax  it  to  the  bridge  abutments. 


Fig.  122.     Supplies  before  and  after  casting. 


128  CROWNS   AND    BRIDGES 

2.     FACINGS   WITH    DOUBLE    BACKINGS  (Supply  II) 

Bevel  back  of  cutting  edge  of  facing. 

Cut  out  31-gauge  24-karat  backing  to  extend  from  the  ridge 
lap  and  bej^oncl  the  cutting  edge.  Anneal,  punch  holes  for  pins 
and  burnish  it  on  the  facing.  Then  insert  in  modelling  com- 
pound and  swage,  but  do  not  have  backing  bent  over  cutting 
edge. 

Cut  a  26-gauge  18-karat  backing  to  extend  from  below  pins 
to  over  cutting  edge.  Punch  holes.  Burnish  and  swage  this  in 
place  over  the  first  backing.     Do  not  swage  second  24-gauge 


Fig.  123.     Facings  with  single  and  double  backings. 

backing  on  thin  or  narrow  teeth,  as  the  facing  is  liable  to 
crack.  Bend  such  a  backing  approximateh-  to  fit,  and  till  the 
space  between  the  two  backings  with  solder. 

Remove  backings  and  unite  them  by  flowing  solder  between 
them  so  that  this  will  show  at  all  edges.      (Figure  63.) 

Boil  in  20%  sulphuric  acid. 

Replace  the  backings  on  the  facing  and  burnish  it  around 
the  pins  with  a  hollow  burnisher.     Do  not  cut  or  split  the  pins. 

File  to  an  approximate  finish;  then  wax  the  facings  to  the 
abutments. 

Remove  the  model  from  the  articulator,  cut  surplus  plaster 
off  and  invest  in  a  good  investment,  so  that  nothing  is  exposed 
except  the  backing  and  metal  of  the  abutments.  A  small  in- 
vestment ring  is  often  very  advantageous  to  hold  the  case  to- 
gther. 

Cut  the  investment  to  get  free  opening  to  the  parts  to  be 
soldered. 

Heat  slowly  over  the  flame  and  solder. 

3.     FACINGS   WITH   SWAGED   CUSPS  (Supply  III) 

Grind  suitable  facing  to  fit  the  gum  and  the  bite,  leaving  a 
space  of  24  gauge  between  edge  and  occluding  teeth. 
Bevel  the  cutting  edge  of  facing  on  the  back  side. 


FIXED  BRIDGES  129 


Swage  31-gauge  pure  gold  backing  to  the  facing,  allowing 
it  to  extend  tjV  of  an  inch  over  tlie  cutting  edge.  Wax  the 
backing  to  the  pins  and  the  whole  on  the  articulated  model, 
using  sticky  wax. 

Build  cusps  with  pink  base  plate,  wax  and  occliule  to  get 
tlie  imprint  of  the  opposite  teeth,  then  carve  the  occlusial  sur- 
face as  nearly  as  jjossible  to  natural  shape. 

Chill  the  wax  cusps  and  take  an  impression  of  them  in 
moldine. 

Flow  a  Melotte's  metal  die.  Make  a  counter  die  if  neces- 
sary. 

Swage  the  cusps  of  22-  or  24-karat,  31-gauge  gold  plate,  place 
gold  plate  over  the  die,  using  a  small  swager  if  possible. 

Drop  in  nitric  acid  for  a  few  minutes  to  remove  Melotte's 
metal. 

Trim  the  gold  cusps  to  the  proper  size.  Place  them  on  the 
wax  cusps  on  the  model  and  settle  them  to  place  Avith  a  hot 
spatula,  trying  the  occluding  bite.      ( P'igure  12J:A.j 


A  B 

Fig.   124.     Facings  with  swaged  cusps.     A,  normal ;   B,  for  close  bite. 

When  the  case  is  all  set  up,  add  investment  to  the  model  to 
hold  the  cusps  and  backed  facing  in  position.  Invest  in  a  metal 
ring.  Boil  the  wax  out.  Dry.  Heat  np  and  solder,  filling  the 
space  between  palatal  edge  of  cusps  and  cervical  edge  of  the 
backings  first,  then  connect  the  individual  dummies,  and  the 
dummies  to  the  abutments. 

Fill  all  level  with  solder. 

Let  cool  slowly,  cover  the  case  to  prevent  draft  from  touch- 
ing it. 

File  tlie  cutting  edge  of  the  metal  in  a  continuous  line  with 
or  at  an  obtuse  angle  to  the  labial  surface  of  the  facing,  so  that 
the  occluding  teeth  will  not  strike  the  facing. 

Note.— In  very  close  bites,  use  double  backing,  attaching 
cusps  to  a  part  of  the  backing  bevond  the  cuttino-  ed^e  (Fio- 
ure  124B.)  '  ^^     =  •      v      ^ 


130  CROWNS  AND   BRIDGES 

4.     DETACHED    POST   CROWNS   IN    BOX  (Supply  IV) 

Grind  the  porcelain  crown,  which  can  be  hand-carved,  or 
a  stock  crown  to  occlude  and  fit  the  gum  at  the  labial  or  buccal 
side.  Leave  space  enough  for  the  thickness  of  the  box  and  its 
reinforcement. 

Swage  a  box  and  fit  a  post  as  described  in  crown  VIB  or 
VIC.     ( Figure  139A  and  D. ) 

To  add  strength  to  the  box  and  post,  solder  a  piece  of  18- 
or  20-karat  28-gauge  gold  plate  over  the  base  of  the  box.  (Fig- 
ure 139B.) 

Wax  the  boxes  with  teeth  to  the  abutments  and  remove  the 
teeth  before  investing. 

Paint  the  inside  of  the  boxes  with  anti-flux,  cut  the  model 
from  the  articulator,  and  extend  the  investment  to  fill  the  boxes. 

Solder  with  18-  or  20-karat  solder  to  get  about  the  natural 
shape  of  the  teeth, 

5.     STEELE    FACINGS    (Supply  IV) 

Steele  facings  may  be  used  to  advantage  as  supplies  instead 
of  pin  facings,  in  bridgework. 

Grind  Steele  facing  to  fit  the  gum  and  bite.  Do  not  bevel 
the  tip  of  facing  as  is  done  with  pin  facings.      (Figure  125.) 


Fig.  125.     Bridge  with  supplies  of  anterior  Steele  teeth. 

Fit  a  Steele  backing  to  the  ground  facing,  trim  off  over- 
hanging edges  of  the  backing,  except  at  the  incising  edge,  where 
the  backing  should  be  left  longer  than  the  facing.  (Figure 
129. )     Wax,  invest  and  solder. 

When  the  bridge  is  finished,  do  not  file  the  backing  flat  at 
the  end  of  the  facing,  but  use  the  flle  in  a  line  contiuous  with 
the  labial  bevel  of  the  facing. 

Do  not  cement  the  Steele  facings  to  the  backings  until  the 
bridge  has  been  tried  in  the  mouth  and  is  found  to  be  perfect. 


FIXED  BRIDGES 


13; 


Cement  tliem  to  tlie  hriil/^e  before  cementinji'  tlie  latter  into  the 
mouth,  using'  a  right  color  cement. 

Note. — Be  sure  in  all  cases  to  wash  the  bridge  well;  h.ave 
no  acid  on  bridge  backings  or  tooth  boxes,  as  otherwise  a  ce- 
mented tooth  (the  cement)  will  be  affected  by  same  and  drop 
off. 


Fig.  126.     Steps  for  making  of  Steele  anteriors  crown. 
6.     STEELE   POSTERIORS  (Supply  VI) 

In  using  Steele  posteriors  as  supplies  in  bridgework,  first 
grind  the  tooth  to  fit  gum  and  bite. 

Place  Steele  backing  in  place  on  the  tooth.  Burnish  or 
swage  a  piece  of  35-gauge  24-karat  gold  over  the  back  part  of 
the  tooth  not  covered  by  the  Steele  backings,  and  allow  it  to 
extend  slightly  under  the  edge  and  sides  (Figure  132  of  the  lat- 


FiG.  127.     Steele  Anti-flux.     Indispensable   in   crown  and  bridge   work. 


132 


CROPFNS   AND    BRIDGES 


ter).  Wax  the  24-karat  gold  extension  to  the  Steele  backing 
with  sticky  wax  and  remove  it  from  the  tooth.  Paint  the  in- 
side of  backing  and  extension  with  Steele  anti-finx.  (Figures 
127  and  128.)       Invest  and  solder  them  together,  or  hold  in 


■fSS 


Fig.   128.     Painting  of  backing  with   Steele  Anti-flux. 


A  B 

Fig.  129.      (Oblique  line)   right  and  (arrow  point)   wrong  way  of  filing  backings. 


Fig.   130.     Filing  to   remove  obstructions. 


^r-/ ^  / 


Fig.  131.     Bridges  with  Steele  posteriors. 


FIXED  BRIDGES 


133 


place  and  solder  in  open  flame.  (Fij^iire  i:i2.)  Place  backinj^ 
and  extension  back  on  the  tooth,  and  burnish  it  to  accurate  fit. 
To  make  a  box,  use  a  common  leather  or  ticket  punch  and  punch 
hole  in  a  24-karat  gold  plate,  solder  plate  to  Ijackino-  (Fioi,r(^ 
134).     Swage  to  Steele  posterior  or  as  per  Figure  139D. 


Fig.  132.     Soldering  extension  to  backing. 


Fig.  133.     Fitting  to  tootli. 


0 


Fig.  134.     Steps  for  making  of  box  of  Steele  posterior. 


Fig.  135.     Above  bridge  with  short  teeth,  and  short  gold  crown  abutments ;  this 
has  no  wash   spaces,  and  its  weakest  point  is  where  the  Steele  posterior  molar 

joins  the  gold  crown. 


134 


CROWNS   AND    BRIDGES 


Place  backed  tooth  in  position  on  the  model  in  its  proper 
relation  to  the  abutments.  Wax  backings  to  the  abutments. 
Kemove  teeth  from  backings.  Paint  inside  of  backings  with 
Steele  anti-flux.  Invest  and  solder  the  dummies  and  abutments 
together. 

Note. — To  obtain  strength  and  Avash  space  in  close  bite 
cases  when  the  Steele  posterior  fits  close  to  the  gum  margin  and 
the  abutment,  leave  a  V-shaped  space  between  Steele  tooth  and 
gum  margin.        (Figure  136.)       Burnish  or  swage  the  Steele 


Fig.  136.     Steele  posterior  molar  with  slice  cut  from  the  distal  side ;   this  will 
overcome  the  weak  place  next  to  its  abutment,  as  shown  in  case  above. 

backing  over  the  bevelled  surface  and  proceed  as  above.  Base 
metal  posts  and  backings  as  these  will  not  stand  the  soldering 
and  acid. 


@iqp 


Fig.  137.     Notice  the  wash  space  and  freedom  of  the  festoon  next  to  crown  abut- 
ments and  dummies.     This  is  very  important  and  should  be  provided  for  in  all 

fixed  bridges. 


7.     GOSLEE  TOOTH  (Supply  YU) 

Goslee  teeth  can  be  used  as  dummies  with  or  without  saddle, 
as  the  case  may  call  for. 

Grind  Goslee  tooth  to  fit  the  bite  and  the  gum,  leaving  suffi- 
cient space  between  gum  and  Goslee  tooth  for  thickness  of  box, 
as  described  for  crown  VIC. 

To  swage  a  box  for  a  Goslee  tooth,  invest  the  to^th  in  mod- 
elling compound  as  shown  by  centre  (Figure  139D.) 

Swage  35-gauge  pure  gold  box. 

Solder  a  post  to  the  box  and  reinforce  same.  (Figure 
189B.) 


39  CHl 


.Jk^JUk._'^_  ri 


I .  liJ 


49 


i^l  ^mmQry 


Fig.  138.     Anterior  and  posterior  Goslee  teeth. 


H 

Fig.  139.     Steps  to  show  making  of  boxes  for  Goslee  teeth,   or  other  porcelain 

crown. 


136 


CROWNS   AND   BRIDGES 


If  the  box  with  post  is  soldered  to  a  cap  or  a  saddle 
(Figure  139C),  it  will  give  sufficient  strength. 

In  other  cases  one  cannot  depend  on  the  reinforcement  of 
the  boxes  with  solder  only.  In  many  cases  the  solder  is  drawn 
or  polished  from  the  box  and  weakens,  as  shown  by  arrows 
A  and  B,  Figure  139B. 


Fig.  140.     Anterior  Goslee  bridge. 


Fig.  141.     Posterior  Goslee  bridge. 


To  prevent  the  post  from  being  pulled  out  of  the  box,  and 
to  prevent  the  solder  from  being  drawn  away  from  the  high 
point  (A),  bend  and  solder  a  strip  of  18-  or  20-lvarat  gold  plate 
26-  or  28-gauge  to  the  box,  as  shown  in  Figure  139B. 

This  can  be  done  in  the  open  flame  or  in  an  investment.  It 
should  be  done  before  soldering  the  box  to  the  abutment. 

8.     EVSLIN   INTERCHANGEABLE   TEETH  (SUPPLY  VIII) 

This  type  of  porcelain  supplies  comes  with  ready-made, 
adaptable  backings.  Perfect  boxing  can  be  obtained  (Figure 
142)  by  swaging  the  backings  to  the  Evslin  tooth. 


Fig.  142.     Evslin  interchangeable  teeth  for  crown  and  bridge  work. 


FIX  HI)   BRIDCES 


137 


G.     ASSEMBLING    BRIDGES 

Bridge  I 

I.     SANITARY    BRIDGES 
a.  Sanitary  bridges  with  gold  chewing  surfaces 

After  tlie  supply  is  cast,  it  is  waxed  to  the  abutments. 
(Figures  121-122.) 

Fill  the  space  between  the  snp]»lv  and  unui  ^\\\\\  investment. 
(Figure  143.) 


Fig.   143.     Soldering  of   casting  to   all  metal   abutments. 

Eemove  the  model  from  the  articulator,  trim  it  to  small 
size  and  heat  it  slowly. 

Solder  from  the  occlusal  surface  with  18-  or  20-karat  solder, 
stone  and  polish. 


Fig.   144.     Top   view   of   sanitary  bridge. 


Fig.   145.     Sanitary  bridge  witli  gold   casting. 


138  CROWNS   AND   BRIDGES 

b.  Sanitary  bridges  with  porcelain  chewing  surfaces.  _> 

Bridge  IV. 

If  there  is  sufficient  space  between  the  teeth  of  the  opposite 
jaw  and  the  gum,  use  detached  post  crowns,  or  other  porcelain 
boxed  teeth,  to  get  a  porcelain  chewing  surface,  which  masti- 
cate better  and  give  a  better  appearance.  This  is  especially 
important  for  orators  or  singers.  These  porcelain  crowns 
should  be  trimmed  down  sufficiently,  however,  so  as  not  to  take 
up  too  much  space.  The  gold  underneath  is  again  V-shaped, 
so  that  it  can  be  easly  kept  clean  from  both  sides. 

Make  a  model  witli  the  abutments  and  grind  the  detached 
post  crowns  or  diatoric  teeth  to  get  a  good  occlusion.  Then 
shorten  them  at  the  lower  part,  but  not  enough  to  weaken  tln^ 
crown. 

Proceed  as  described  for  supply  IV. 

After  the  bridge  is  invested  and  heated  up,  floAv  18-  or  20- 
karat  solder  over  the  boxes.  Sometimes,  especially  if  the 
bridge  is  long,  it  needs  to  be  reinforced  with  a  strip  of  18-  or  20- 
karat  plate  gold  placed  over  the  boxes.  The  boxes  could  also  be 
waxed  together,  cast  and  then  soldered  to  the  abutments. 

Stone  grind  and  polish.      (Figure  146.) 

2.     SELF    CLEANING    BRIDGES   (Bridge  III) 

Fit  supplies  and  wax  them  in  the  correct  position  on  the 
articulated  model. 

Make  a  plaster  core  around  supplies  and  abutments. 

Boil  out  the  wax,  study  and  mark  the  teeth  for  length  of 
backings. 

Remove  supplies  from  the  core  and  fit  the  backings  or  boxes. 

Backings  must  reach  to  the  gum  line.  Test  this  by  placing 
the  supplies  with  backings  on  the  model  with  cores.  (Figure 
65.) 

Boxes  must  clear  the  gum  line  sufficiently  to  allow  for  their 
reinforcement,  Avhich  is  not  less  than  24  gauge. 

Place  cores  on  the  models  and  supplies  into  same,  wax  the 
supplies  together  (not  more  than  four  in  a  section,  use  a  wire 
in  the  wax  for  stiffener.      ( Figure  208. ) 

Remove  this  waxed  section,  from  the  core,  invest  and  solder 
(or  cast).     (Figure  209.) 


Before. 


After. 


Fig.  146.     Sanitary  bridge  with  porcelain  chewing   surface. 


140  CROWDS   AND    BRIDGES 


Fig.   147.     Self-cleansing  bridge   showing  wash   spaces. 

Boil  the  soldered  section  and  replace  it  in  tlie  core  on  the 
model. 

Wax  soldered  dummies  or  sections  to  the  abutments. 

Remove  the  cores,  invest  the  whole  bridoje  on  the  model  in 
plaster  and  Portland  cement,  or  other  investment. 

Solder  the  supplies  to  the  abutments  as  shown  in  Figure  65. 

Cool,  boil  in  acid,  stone  and  polish. 

3.     SADDLE    BRIDGES   (Bridge  IV) 
Continuous  saddle 

Outline  the  area  on  the  model  to  be  covered  by  the  saddle. 
(Figure  148.) 

Swage  or  cast  the  saddle.  Swaged  saddles  can  be  made  of 
gold,  but  are  better  of  platinum  32-gauge.  The  latter  are  the 
cleanest.  Cast  saddles  are  made  hj  pressing  thin  casting  wax 
over  the  model,  and  trimming  it  to  the  outline.  Put  sprue  into 
the  center,  and  paint  with  inlay  investment.  After  this  has 
hardened,  remove  it  from  the  model,  invest  and  cast.  Thin 
platinum  saddles  can  be  stiffened  by  gold  casting  to  same. 

Place  the  saddle  on  the  model. 

Follow  steps  as  for  bridge  II. 

Backings  and  boxes  may  rest  on  the  saddle.      (Figure  150.) 

Place  supplies  on  the  model  with  cores.      (Figure  149.) 

Wax  supplies  to  the  saddle. 

Remove  core  from  the  supplies  and  model. 

Remove  teeth  from  the  boxes,  and  paint  the  inside  of  the 
boxes  with  Steele  anti-flux. 

Remove  saddle  with  waxed  boxes  from  model.  Cast  with 
20-karat  gold. 

Invest  and  solder.      (Figure  150.) 

Boil  in  acid,  and  rough  stone  this  section. 


Fig.  148.     Saddle  bridge.     Teeth  in  core  before  boxing. 


Fig.  149.     Saddle  bridge.     Teeth  boxed. 


Fig.   150.     Saddle  and  boxes  invested   ready  for  solder;   investment  opens   from 

front  and  back. 


142 


CROWNS   AND    BRIDGES 


Fig.  151.     Saddle  bridge,  before  and  after  cementing  of  supplies. 

Place  back  ou  to  model,  and  wax  it  to  the  abutments. 

Invest  the  whole  bridge  on  the  model,  in  a  ring  with  plaster 
and  Portland  cement. 

Boil  the  Avax  out,  solder,  boil  in  sulphuric  acid,  stone  and 
polish.  Care  should  be  taken  to  allow  sufficient  space  between 
the  abutments  and  the  saddle  for  the  faestum  of  the  gum. 

Porcelain  saddles 

If  there  is  a  great  deal  of  absorption  of  tissue,  saddle  bridges 
sometimes  necessitate  the  showing  of  gold  to  avoid  too  long 
teeth.     This  can  be  overcome  by  the  use  of  gum  blocks,  either 


Fig.   152  shows  a  banded   porcelain  molar   crown,   and  bicuspid   dummy.     The 

slotted  porcelain  crown  and  dummy  were  carved  in  one  piece  and  cemented  to 

metal  base  on  molar  roots. 


FIXED  BRIDGES  143 


baked  and  soldered  to  the  saddle,  or  still  better  by  entire  gum 
blocks  with  i)orcelain  saddles.  These  are  attached  to  hoth 
abutments  by  bars  extending  from  bi'idge  abutments  and  being 


Fig.   153.     Hand-carved   porcelain   blocks   with   porcelain    saddles. 

cemented  into  the  block.  They  are  very  clean  and  give  excel- 
lent effect.  (Figures  152  and  153.)  Follow  general  instruc- 
tion as  for  making  single  hand-carved  crown. 

Individual  saddles 

When  planning  to  use  a  saddle,  make  a  thorough  examina- 
tion of  the  ridge  which  is  to  be  covered  by  the  same.  It  is 
almost  always  necessary  to  carve  the  plaster  model  to  allow 
the  saddle  to  set  firmly  on  to  the  ridge,  without  having  an  open- 
ing at  any  place  except  next  to  the  abutments. 

Individual  saddles  are  most  practical  for  dummies,  which 
are  carried  by  abutments  at  each  end,  such  as  from  cuspid  to 
molar  bridge,  or  bicuspid  to  molar  bridge. 

These  individual  saddles  permit  wash  spaces  between  each 
crown  and  dummy,  which  is  of  great  advantage  in  the  cleaning, 
also  to  the  feeling  to  the  tongue,  as  it  is  more  natural,  is  the 
nearest  restoration  to  nature  of  the  missing  teeth.  (Figure 
139C.) 

Continuous  saddles  are  more  practical  for  extension  bridges, 
such  as  shown  in  Figures  151  and  210.     These  continuous  sad- 


144 


CROWNS   AND    BRIDGES 


dies  are  also  used  to  cover  a  larger  surface,  but  this  all  depends 
on  the  strength  of  the  abutments,  the  bite  and  the  ridge.  In  all 
cases  the  platinum  saddle  is  preferable  to  the  gold,  be  it  for  a 
cast  or  a  soldered  bridge.  Platinum  or  porcelain  saddles  are 
less  irritating,  and  have  proven  cleaner  than  gold  saddles,  in  all 
practical  cases. 

4.     EXTENSION   BRIDGES   (Bridge  VI) 

Fixed  extension  bridges  are  always  saddle  bridges.  The 
force  of  mastication  should  be  taken  up  b}^  the  alveolar  ridge, 
to  a  great  extent,  and  not  so  much  by  the  abutments.  The 
further  away  we  can  remove  this  pressure  from  the  abutments 
the  longer  will  these  last. 


Fig.   154.     Extension  bridge   from   front   and   back;   note   space   for   festoon,   to 
allow  for  gum  between  crown  and  saddle. 

The  construction  of  these  bridges  is  similar  to  the  foregoing 
ones,  being  usually  saddle  bridges,  with  abutments  only  on  one 
side.      (Figures  154  and  151.) 

{ Bridge  VII  ) 
Interlocking  bridges 

Whenever  it  is  impossible  to  line  up  or  bring  into  parallel 
lines  the  teeth,  and  roots,  which  are  used  for  bridge  abut- 
ments, one  can  use  an  interlocking  device,  by  which  the  diffi- 
culty of  fixed  bridges  is  overcome.  Various  devices  such  as 
the  Morgan  attachment,  the  Roach  attachment,  the  split-bar 
attachment,  and  many  others,  are  offered  for  sale  by  the  dental 
depots,  and  all  of  them  have  their  place  in  this  line  of  work. 
See  description  of  these  appliances.  (Figures  184-191.) 
If  the  dentist  does  not  care  to  use  any  of  these  appliances, 
but  prefers  to  make  his  own,  he  can  easily  accomplish  this  in 
the  following  manner.  Make  a  dove-tail,  or  tube  attachment, 
either  by  bending  double  plates  and  reinforcing  same  with 
solder,  or  by  tile  casting  process.  Care  must  be  taken  in  all 
cases  to  set  these  attachments  at  a  right  angle  or  in  parallel 
line  with  the  fixed  abutment.      (Figures  17  and  18.) 


IX.    REMOVABLE  BRIDGES 

Removable  bridges  are  the  next  step  to  the  fixed  bridges  for 
the  replacement  of  lost  teeth.  If  the  abutments  are  not  strong 
enough  to  support  the  new  teeth,  for  fixed  bridges,  then  use  the 
alveolar  process  to  support  the  appliances.  These  bridges,  if 
well  constructed,  and  in  the  right  place,  are  very  useful,  al- 
though they  are  not  as  ideal  as  fixed  bridges;  nevertheless,  they 
are  far  superior  to  a  plate.  Dr.  Pieso's,  Dr.  Ash's,  and  other 
removable  bridge  systems  have  been  described  so  often  in  the 
past,  that  I  will  content  myself  with  the  later  and  less  known 
systems,  such  as  the  Gilmore,  Roach,  and  Morgan  types. 

A.     REMOVABLE   BRIDGES   WITH   GILMORE 
ATTACHMENT 

GENERAL  DESCRIPTION   OF   TECHNIQUE 
PREPARING   GAPS   AND   POST   FOR   GILMORE   ATTACHMENTS 

The  Gilmore  attachment  is  a  V-shaped  clasp  ( Figure  1 83 ) . 
This  clasp  is  fastened  to  the  removable  bridge  saddle  (or  plate j , 
and  is  engaged  to  a  14-gauge  platinized  gold  wire,  which  is  sold- 
ered to  a  crown,  cap  or  inlay.  This  wire  can  be  extended  from 
a  single  abutment,  or  the  wire  can  be  soldered  to  two  or  more 
abutments,  and  as  many  attachments  used  as  to  the  size  of  the 
bridge. 

Great  care  must  be  taken  in  the  preparation  of  such  roots, 
and  teeth  to  be  used,  if  they  are  to  he  connected  hy  the  gold 
icire;  the  posts  in  the  root  canals  and  the  gold  croAvns  or  inlays 
must  be  parallel  to  one  another.  (See  Figure  159.)  The 
Ijridge  meter  is  of  great  value  in  tliis  work.  (Figure  201.) 
With  a  single  extension  no  such  care  is  necessary. 

It  is  advisable  to  start  trith  a  simple  case,  such  as  a  remov- 
able bridge  between  a  cuspid  and  molar,  or  bicuspid  and  molar 


146  CROWNS  AND   BRIDGES 

witli  crowns.  After  making  the  crowns  in  the  usual  manner, 
take  a  wax  bite  and  a  plaster  impression  of  the  crowns  in  place 
and  of  the  tooth  space. 

Before  placing  the  crowns  back  into  the  plaster  impression, 
line  the  inside  of  the  crowns  with  a  thin  film  of  wax,  so  that 
when  the  model  is  made,  the  crowns  can  be  warmed  and  pulled 
off. 

Make  an  articulated  model,  warm  the  crowns  and  pull  them 
from  the  model,  boil  off  the  wax  and  place  them  back  on  to  the 
model. 

Fit  a  14-gauge  platinum  wire  from  crown  to  crown,  bending 
the  end  of  the  wire  upAvard.  ( Figure  1 83,  B  and  C. )  The  wire 
should  lay  on  top  of  the  ridge,  if  possible. 

Wax  the  wire  to  the  crowns,  remove  all  from  the  model,  in- 
vest and  solder  wire  to  the  crowns. 

Place  the  gold  frame  back  onto  the  plaster  model. 

Now  proceed  with  making  a  cast  or  SAvaged  saddle. 

Another  simple  case  to  start  with,  would  be  to  solder  an  ex- 
tension wire  to  the  lower  bicuspid  crowns.  ( See  cases  Figures 
179,  182,  183B  and  C.) 

Solder  the  gold  wire  (14-gauge)  to  the  crow^ns,  take  bite  and 
impression  in  plaster. 

Make  a  partial  lower  gold  bar  denture,  gold  or  rubber  sad- 
dles with  a  Gilmore  attachment  at  each  end.  In  setting  the 
crowns  with  the  wire  extension,  it  is  best  to  place  the  crowns 
with  the  wire  in  the  attachment  on  the  denture  and  then  cement 
ilie  croiois  icith  the  denture  to  place. 

In  using  roots  for  abutments  it  is  well  to  Ituild  the  root 
caps  to  the  level  of  the  gum,  as  otherwise  the  gums  will  fold  over 
the  root  caps,  and  it  is  hard  to  care  for  them  by  the  patient  and 
dentist. 

The  wire  can  extend  to  one  side  of  a  root  cap,  but  I  have  had 
my  best  results  by  soldering  the  wire  across  the  root  cap,  ex- 
tending mesially  and  distally  with  an  attachment  at  each  end. 
(Figures  170,  171.) 

For  the  construction  of  large  frames  and  to  finish  the  bridge 
such  as  shown  in  Figures  173,  174,  loith  one  plaster  impression 
(with  the  abutments  in  place)  do  as  follows: 


REMOVABLE  BRIDGES 


147 


FITTING    PLATINIZED   GOLD   WIRE   TO  THE  ABUTMENTS  FOR 
GILMORE   ATTACHMENT 

Place  abutments  in  position  on  roots  or  teeth. 
Take  Avax  l)ite  and  ])laster  impression  ;is  for  n  rubber  plate. 
(Figure  155.) 


Fig.    155.     Plaster   impression   of   four   abutments. 


Before  placing  the  abutments  in  the  f)laster  impression,  flow 
a  thin  fllm  of  wax  over  the  posts  and  inside  of  the  bands  and 
crowns,  so  that  they  can  be  removed  later  from  the  plaster 
model. 

Make  a  plaster  model.      (Figure  156.) 

Mount  model,  and  bite  on  an  anatomical  articulator. 


148 


CROWNS  AND   BRIDGES 


Kemove  the  wax  bite.  Shellac  or  varnish  plaster  model, 
and  take  a  plaster  impression  of  the  model  with  the  abutments 
in  place.     This  is  for  a  large  case  only. 

Note.— Care  must  be  taken  to  fill  with  wax  all  undercuts  on 
the  model,  so  as  not  to  break  the  model  when  removing  the 
plaster  impression  from  it. 


Fig.    156.     Plaster   model   with    four   abutments. 


Eemove  the  plaster  impression;  heat  and  remove  the  abut- 
ments from  model  (Figure  157)  and  place  the  abutments  in 
their  positions,  in  the  netv  plaster  impression,  making  them  se- 
cure by  flowing  a  little  sticky  wax  around  their  edges.  Make 
this,  the  second  model,  of  plaster  and  Portland  cement  or  other 
good  investment. 

To  this  model  fit  a  round  11-ga.uge  18-karat  platinized  gold 
wire  over  the  center  of  the  root-abutment,  and  over  the  ridge  of 
the  gum,  so  that  it  barely  touches  the  model  between  the  abut- 
ments. 

If  the  posterior  abutment  is  a  crown,  bend  the  wire  so  that 
it  will  fit  upright  on  the  center  of  its  mesial  surface.  (Fig- 
ures 185B  and  C.) 


REM  O I  'A  BL  li  nRJI)  C; ES 


149 


Fasten  tlie  gold  wire  to  the  model  with  binding  wire,  and 
solder  the  wire  to  tlie  abutments  with  18-karat  solder. 

Boil  the  framework  in  aeid  and  place  it  on  the  first  original 
plaster  model.        (Figure  157.)        Figure   158  sliows  finished 


Fig.  157.     Abutments  removed  from  model  to  solder  wire  frame. 


Fig.   158.     Finished  frame   in   position. 


150 


CROfVNS  AND   BRIDGES 


frame.  In  small  cases  the  gold  wire  could  be  fastened  to  the 
abutments  of  the  original  model  with  sticky  wax ;  taken  off  the 
model,  invested,  and  soldered. 


Fig.   159.     Finished    frame   for   another   case. 
Making  of  bridge  proper 

Place  a  plain  opened  Gilmore  attachment  (Figure  183,  No. 
5)  {i.e.,  without  any  extension)  over  the  wire  where  desired, 
and  make  a  swaged  or  cast  saddle  to  cover  the  framework,  the 
attachment  and  as  much  of  the  gum  ridge  as  you  wish  to  cover. 
(Figure  183H.) 

Making  of  cast  saddles 

Place  a  jDlain  open  dummy  attachment  over  the  wire  (Fig- 
ure 183,  No.  5)  ;  slightly  oil  or  vaseline  all  the  territory  to  be 
covered  b}^  the  model  wax.  On  removing  the  wax  it  will  be 
found  to  bear  an  imprint  of  the  attachment  and  bar,  which 
features  are  reproduced  in  the  casting,  indicating  the  position 
the  attachment  should  occupy  in  the  completed  case.  The  ob- 
ject in  using  ojieii  attachments  is  to  prevent  tlie  metal  from 
being  in  absolute  contact  with  the  free  wings  of  the  attach- 
ment, after  the  gold  attachment  has  been  soldered  in  position, 
and  also  to  create  a  channel  on  each  side  of  the  clasp,  so  that 
it  can  be  adjusted  for  tension. 

In  partial,  and  full  cases  as  well,  I  would  like  to  point 
out  the  importance  of  placing  the  clasps  or  attachments 
"straight"  on  the  wire,  for  if  the  attachment  is  tilted  to  one 
side,  the  plate  or  saddle  to  which  it  is  fastened  will  spring  up 
from  the  wire  during  mastication. 

When  the  extension  wires  run  parallel  to  one  another 
(Figure  182),  the  denture  will  slide  back,  and  leave  a  space  to 
the  adjoining  teeth.  This  is  overcome  by  soldering  a  knob  at 
the  end  of  each  extension  wire,  and  set  the  attachment  close  to 
this  knob. 


Fig.  160.     Frame  and  Gilmore  Attachments  in  position  on  flasked  model. 

Before  packing  with  rubber,   tinfoil  the  whole  case,   open  the  attachments,  and 

cement  them  over  the  tinfoil  to  place. 


Fig.   161.     Other  half  of   flask. 


152 


CROWNS   AND   BRIDGES 


This  knob  can  be  produced  by  heating  the  end  of  the 
gold  wire  until  it  melts,  and  forms  a  thickened  round  end. 

A  gold  color  soldered  to  the  end  of  the  wire  will  also 
answer  the  same  purpose. 

Whenever  the  extension  wires  are  spread,  as  in  Figure 
179,  no  trouble  of  sliding  of  the  denture  will  be  experienced. 

For  one  side  dentures  (see  Figure  180),  I  have  found 
this  loop  extension  with  two  attachments  very  practical. 


Fig.  162.     A  full  lower  Gilmore  denture.     Case  before  treatment. 

Cut  a  slot  through  the  saddle  over  the  center  of  the 
position  of  the  attachments. 

Fit  attachment  No.  6,  Figure  183  (with  the  pin  through 
the  slot  in  the  saddle) . 

Open  the  attachment  slightly  to  allow  it  to  slip  on  and  off 
the  wire  easily,  then  paint  the  sides  of  the  attachments  with 
Steele  anti-flux.  Place  it  in  position  in  the  saddle,  and  wax 
the  extension  to  its  outer  surface  with  sticky  Avax. 

Invest  the  inside  of  the  saddle  and  the  clasps.  Remove  the 
sticky  wax  and  solder  the  clasp  extensions  to  the  saddle  with 
18-karat  solder  from  the  occlusal  side. 

Note. — Great  care  must  be  taken  to  have  the  attachment 
in  a  vertical  axis.     Gilmore  attachments  must  all  be  parallel 


Fig.    163.     A   full   lower  Gilmore    denture   after   treatment.     Finished    frame   on 

model. 


Fig.  164.     Full  upper  Gilmore  denture.     Frame  finished  to  show  abutments  and 

gold    wire    on    model. 


154 


CROWNS   AND   BRIDGES 


to  each  other,  as  a  slight  tilting  of  the  attachments  will  make 
it  very  difficult  to  seat  and  remove  the  saddle. 

Place  the  swaged  or  cast  saddle  with  attachments  on  the 
articulated  model. 

Grind  all  supplies  into  position  and  wax  them  to  the  saddle. 

Follow  steps  as  for  ordinary  saddle  bridges.  (See  bridge 
IV.) 

Place  supplies  into  the  core  on  the  model. 

Backings  and  boxes  may  rest  on  saddle  or  plate. 

Wax  supplies  to  the  saddle. 

Kemove  saddle  with  the  supplies  from  the  model. 


Fig.    165.     Another   full   lower   Gilmore   case.     Finished   frame    on    model. 

Paint  the  Gilmore  clasps  in  back  of  saddle  with  Steele's  an- 
ti-flux. 

Invest  the  Avhole  into  a  ring  or  band. 

Boil  the  wax  out,  heat  carefully  and  solder. 

Boil  in  acid,  stone  and  polish.  Now  close  the  open  attach- 
ment to  fit  the  wire  soldered  to  the  abutments.  This  is  done  by 
placing  a  piece  of  a  wire  inside  of  the  clasp  and  applying  pres- 
sure with  flat-nose  pliers.  Splendid  results  have  been  obtained 
with  this  attachment  in  small  and  large  cases  alike. 

Roots  slanted 

If  the  roots  are  slanted,  one  is  not  able  to  use  a  fixed  frame- 
work, and  then  one  has  to  devise  variations  as  required  for  spe- 


REMOr/JBLE  BRIDGES 


155 


cial  cases.  Hncli  a  ease  is  sliown  in  Fionre  220.  To  tlie  cus- 
pid caps  is  soldered  a  loop  allowing  the  caps  and  posts  to  swing 
in  position  of  the  slanting  cuspid  roots;  the  other  four  caps  are 
soldered  to  the  gold  wire. 


Fig.   166.     Full  upper  Gilniore  denture.     Case  before  treatment. 


Fig.   167.     Same  case  with  finished   frame   in   position. 


156 


CROWNS   AND    BRIDGES 


Material 

These  bridges  can  be  made  in  various  ways,  as  for  tempo- 
rary bridges,  by  using  rubber.  Also,  if  the  patient  cannot  af- 
ford gold,  other  material,  such  as  rubber  or  combinations  of 
gold  saddle  with  rubber  attachments,  can  be  used.  The  differ- 
ent combinations  are : — 

1.  Eubber. 

2.  Gold  saddle  with  hand-carved  teeth,  detached  post 
crowns,  Goslee  or  Steele  tooth  and  similar  teeth. 


Fig.  168.     A  plaster  model  of  the  back  of  finished  denture. 

3.  Platinum  saddle  with  crowns,  Goslee  or  Steele  teeth, 
hand-carved  teeth  or  detached  post  crowns,  or  others. 

4.  Platinum  saddle  with  gum  blocks. 

5.  Platinum  saddle  with  teeth  soldered  on,  or  continuous 
gum  baked  on. 

Different  kinds   of   bridges   with   Gilmore  attachments   as 
shown  (Figures  158  to  182.") 

1.      FULL  BRIDGES    (Removable  Bridge  I) 

Very  frequently  there  are  only  a  few  roots  or  teeth  left  in 
the  mouth,  and  as  they  would  be  too  weak  to  serve  as  abutments 


REAW  yABLE  BRID  GES 


157 


for  a  fixed  bridge,  they  could  be  utilized,  when  in  healthy  con- 
dition, for  the  retaining  of  a  removable  bridge.  The  principle 
of  the  removable  bridge  is  to  bring  most  of  the  stress  of  masti- 
cation on  the  alveolar  process  and  gum,  so  as  to  prevent  the 
attachments  from  being  forced  out  of  place  by  the  force  of  the 
bite,  tlie  tongue,  cluH'ks,  lips,  etc.  It  is,  of  course,  of  greatest 
importance  to  set  the  teeth  up  for  anatomical  articulation,  so 
that  mastication  does  not  strain  the  attachments,  on  acc<)nn' 
of  faulty  occlusion. 


Case:  Figure  169.  This  patient,  7Z  years  of  age,  had  but  one  good  upper  cus- 
pid tooth,  but  a  complete  lower  set  of  her  own  teeth.  She  had  a  very  flat 
palate,  and  had  never  worn  a  plate  of  any  kind.  Gilmore  attachment  was  made 
as  follows:  The  upper  cuspid  was  cut  off,  and  a  swaged  platinum  cap  with  a 
platinum  post  was  fitted  to  the  root.  To  this  cap  and  post  a  14-gauge  platinum 
gold  wire  was  soldered;  this  wire  was  pointed  toward  the  center  of  the  palate. 
A  Gilmore  attachment  was  fitted  almost  to  the  end  of  the  wire,  and  over  this 
a  thin  20-karat  gold  plate  of  36  gauge  was  swaged,  also  having  a  gold  mesh 
wire  soldered  on  the  surface.  (This  is  known  as  a  Perfection  gold  plate.)  To 
this  the  clasp  was  soldered,  and  a  full  upper  set  of  14  teeth  were  vulcanized  to 
the  plate.  The  patient  could  wear  the  plate  with  comfort  from  the  first  day, 
and  as  yet  the  root  shows  no  sign  of  loosening.  Tf  later  the  root  should  give 
way,  the  patient  no  doubt  would  then  find  no  difficulty  in  wearing  a  plate  that 
was   dependent  wholly   upon   suction. 


158 


CROWNS   AND   BRIDGES 


One  can  ntilize  even  one  strong  single  root  for  this  purpose. 
(Figures  169  and  171.)  Two  or  more  are  of  course  of  greater 
advantage  ( Figures  170,  165,  163,  etc. ) ,  and  insure  longer  ser- 
vice. It  is  advisable  to  make  a  full  plate  with  the  attachment 
to  any  weak  supports,  as  narroAV  ridge,  or  skeleton  plates,  bring 
too  much  pressure  on  the  abutments.  (This  refers  to  full 
cases.)  The  illustrations  show  various  practical  cases  that 
have  proven  very  satisfactory. 


Fig.  170.     Full  lower  with  two  roots  and  two  Gilmore  attachments. 


2.     PARTIAL   BRIDGES    (Removable  Bridge  II) 

For  partial  removable  bridges,  gold  crowns,  banded  porce- 
lain crowns,  and  inlays  are  of  the  most  frequent  abutments 
used.  These  small  bridges  can  be  made  by  different  methods, 
and  some  of  these  methods  are  here  described. 

3.     PARTIAL   BRIDGES   WITH  VAULT    BAR  (Removable  Bridge  III) 

If  a  number  of  teeth  on  both  sides  of  the  mouth  are  to  be 
supplied,  it  is  of  advantage  to  connect  them  with  a  vault  bar 
to  prevent  lateral  stress.  This  bar  is  closely  adapted  to  the 
palate.  Take  a  strip  of  pure  gold  30  gauge  and  burnish  it  on 
the  model,  from  one  saddle  to  the  other.  This  is  then  rein- 
forced with  an  oval  bar  of  platinized  gold,  and  soldered  to  the 
strip  of  pure  gold  and  also  to  the  saddles  of  the  two  lateral 
parts  of  the  bridge.     The  vault  bar  should  be  so  constructed 


Fig.  171.  Full  lower  with  one  root  using  two  Gilmore  attachments.  This  was 
a  case  one  could  not  expect  too  much  from  as  far  as  the  lasting  of  this  one 
root  was  concerned,  but  time  has  proved  it  to  be  satisfactory  beyond  all  ex- 
pectations.    It  helped  the  patient,   an  old   lady,  to  get  accustomed  to  the  plate. 


160 


CROWNS   AND    BRIDGES 


that  it  does  not  interfere  with  the  movements  of  the  tongue  in 
speaking.     As  a  rule,  it  should  be  as  far  back  as  possible. 
Cast  bars  of  clasping  gold  are  good  for  such  cases. 

4.     PARTIAL   BRIDGE   WITH  LINGUAL  BAR  (Removable  Bridge  IV) 

The  above  is  also  true  for  removable  bridges  for  the  man- 
dible. The  two  halves  are  connected  with  a  bar  extending 
along  the  lingual  part  of  the  gum  of  the  front  teeth. 


Fig.   172.     Anterior  fixed  and  posterior  removable  bridge  with   Gilmore   attach- 
ments.    A,    shows   the    roots    before   treatment.     B,    anterior    bridge    with    wire 

extensions   in   place. 


5.     EXTENSION    BRIDGES   FOR   ONE   SIDE    (Removable  Bridge  V) 

If  teeth  are  missing  on  one  side  of  the  jaw  only,  either  in 
the  maxilla  or  mandible,  we  can  use  an  extension  bridge.  The 
Gilmore  wire  is  only  connected  on  one  side  to  the  abutments, 
and  extends  out  over  the  gum.  This  wire  can  also  be  bent  in 
a  loop,  so  as  to  give  attachments  for  two  clasps  laterally.  This 
prevents  motion.      (Figures  180  and  181.) 


i^^^_. 


Fig.  173.     Partial  removable  bridges  with  three  Gilmore  clasps  used  in  this  case,   one  between 

cuspid  and  central,  and  one  between  the  cuspids  and  molars  on  each    side.       A  swaged  saddle 

of  platinum  with  hand-carved  teeth  soldered  to  it. 


B 


Fig.  174.  Removable  partial  bridge.  In  this  case  the  lost  teeth  were  restored 
with  a  removable  bridge.  Gilmore  attachment  wire  was  soldered  on  the  right 
upper  bicuspid  abutment  and  both  cuspid  roots,  and  left  upper  molar.  Ten 
teeth,  some  with  porcelain  gum,  were  soldered  to  a  swaged  platinum  plate, 
having  three  Gilmore  attachments,  one  between  the  cuspid  root  caps  and  two 
between   cuspid   and  molar   on  left   side. 


Fig.  17S.     Partial  lower  removable  gold  denture  held  with  one  Gilmore  attach- 
ment to  second  bicuspid  gold  crown. 


Fig.  176.  Removable  bridge  with  vault  bar.  In  this  case  the  anchorage  v/as  obtained  by 
crowns  to  the  lateral  and  molar  of  the  left  side  and  by  gold  inlays  with  posts  on  two  molars 
of  the  right  side  (Figure  A).  Gold  saddles  with  vault  wire  and  hand-carved  teeth  with 
porcelain  gum  were  used.  Three  attachments,  one  on  the  right  side,  and  two  on  the 
left   side,   held   the  bridge    securely. 


Fig.   177.     Removable  bridge  held  by   three   Gilmore   attachments. 


Fig.    178.     Partial   removable  bridge   witb    vault   I)ar,   two   Gilmore   attacbments. 


Fig.   179.     Partial   removable  bridge  v^'ith  lingual  bar   and  two   Gilmore  attachments.     Extension 

wires   are   soldered   to   bicuspid,   banded   crowns   with   Steele    posterior  supplies.       The  bridge  is 

made  in  gold   with  hand-carved   ?um  blocks. 


^H 

"^^^H 

l^^l 

^B 

^B^T^  -^ 

^^^^^^^^H 

^ 

^^^^^^^1 

H        k;. 

^^^^1 

r    ,^    ~^r^^ 

•""^^^H 

^H                  '% 

'".r  •  '  -SS 

^ 

^^ 

/^i^^^^^^^l 

^^M 

^^ 

Fig.  180.  Removable  extension  bridge  for  one  side.  Case  showing  a  removable 
extension  saddle  bridge.  A  loop  was  soldered  to  an  all-metal  bicuspid  crown, 
which  was  connected  to  an  inlay  with  post  in  the  cuspid.  Two  Gilmore  attach- 
ments were  placed  one  on  each  side  of  the  looped  wire,  and  over  this  a  cast  gold 
saddle  was  made,  and  the  teeth  were  mounted  to  the  saddle,  as  shown.  _  A 
double  attachment  on  a  looped  wire  has  a  great  advantage  over  a  single  wire, 
as  the  looped  wire  prevents  the  backward  sliding  of  the  saddle,  gives  more 
firmness  to  the  bridge,  and  most  of  all  it  affords  great  strength  where  it  is 
needed,  next  to  the  crown. 


Fig.   181.     Top   view   of  finished   case    No.    180. 


Fig.  182.  When  extension  wires  run  parallel,  as  in  this  case,  then  the  denture  with 
the  Gilmore  attachments  is  liable  to  slide  back.  This  should  be  taken  in  con- 
sideration when  soldering  the  wires  to  the  crowns,  soldering  a  collar  or  knob 
to  the  end  of  the  wire,  and  placing  the  attachments  close  to  same,  will  over- 
come all  back  sliding  of  the  denture. 


BUD 


No.  3 


No.  4 


No.  5 


No.  6 


Fig.  183.  Different  styles  of  Gilmore  Adjustable  Attachments.  No.  3,  No.  4, 
No.  5  and  No.  6  are  made  of  a  special  clasp  gold.  B  C  shows  14-gauge  clasp 
gold  wire  soldered  to  gold  crown.  H  shows  No.  6  attachment  soldered  to 
saddle  bridge.  No.  3  and  No.  4  are  also  made  in  special  white  metal  and  are 
intended  for  rubber  work  only  and  are  sold  as  style  No.   1  and  No.  2. 


168 


CROJVNS  AND   BRIDGES 


B.     REMOVABLE  BRIDGES  WITH   ROACH 
ATTACHMENTS 

Removable  Bridge  VI 

The  Roach  attachments  are  constructed  on  the  ball  and 
socket  principle,  which  eliminates  leverage  and  obviates  par- 
alleling, thus  making  its  use  very  simple  and  efficient. 

1.     FITTING  THE   ATTACHMENTS   TO   THE   ABUTMENT 
Fitting  to  gold  crowns 

Make  the  crown  and  adjust  it  in  the  mouth ;  mark  the  loca- 
tion for  the  ball  about  sV  of  an  inch  from  the  gum  lingually, 
so  that  the  attachments  will  line  up  with  the  lingual  surface  of 
the  teeth;  remove  the  crown  from  the  mouth,  drill  a  hole  of  the 
size  of  the  stem  on  the  ball  at  the  point  marked;  cut  the  stem 
short  so  that  it  will  not  project  inside  of  the  crown,  and  solder 


Fig.   184.     Roach  attachments  for  removable  bridges. 

it  to  place.  The  stem  also  may  be  cut  off  to  the  shoulder  and 
the  ball  soldered  to  the  crown  without  drilling  a  hole.  (Fig- 
ure 184.) 


REMOVABLE  BRIDGES  169 

In  some  cases  it  is  advantageous  to  take  an  impression  of 
tlie  crown  in  position  and  locate  the  attachment  on  the  crown 
after  the  model  is  cast. 

Fitting  to  banded  porcelain  crowns 

Construct  caps,  adjust  tliem  in  the  mouth  and  mark  the 
location  for  the  ball,  so  that  it  may  be  waxed  to  place,  invested 
and  soldered  simultaneously  with  the  facing. 

Fitting  to  inlays 

After  a  wax  pattern  is  secured,  warm  the  ball  and  imbed 
the  stem  into  the  wax,  try  it  again  into  the  cavity  to  verify  the 
fit  of  wax  and  the  proper  location  of  ball,  invest  and  cast.  The 
melted  gold  will  unite  with  the  stem  of  the  ball  and  will  need 
no  soldering.  The  inlay  may  also  be  completed,  the  stem  cut 
off,  and  the  ball  soldered  to  the  inlay. 

2.     TAKING   IMPRESSION    FOR    BRIDGE 

The  abutment  with  the  ball  attached  should  now  be  placed 
in  the  mouth,  take  an  impression,  and  form  model,  making  sure 
that  the  abutment  is  securely  held  in  place. 

3.       ASSEMBLING   OF  THE   BRIDGE    WITH    ROACH    ATTACHMENT 

Construct  the  saddle  bridge  in  usual  manner,  placing  the 
tube  over  the  ball.     The  tubes  are  soldered  to  the  bridge. 

One  side  of  the  tube  should  be  left  uncovered  for  the  pur- 
pose of  tightening. 

Tighten  attachment  by  compressing  tube  with  pliers,  plac- 
ing an  end  of  a  match  or  piece  of  wire  in  the  tube  to  prevent 
closing  it  too  much. 

Note. — Open  tubes  slightly  to  facilitate  removal  during  con- 
struction. 

G.    REMOVABLE  BRIDGE  WITH   MORGAN 
ATTACHMENT 


Removable  Bridge  VII 

of  anchoring  bridges  ii- 
riginator  claims  that  li€ 
tachment  out  thoroughly  in  hundreds  of  cases. 


Another  means  of  anchoring  bridges  is  Avith  the  Morgan 
attachment.     The  originator  claims  that  he  has  tried  this  at- 


170 


CROWNS   AND    BRIDGES 


Making  of  the  abutments 

All  the  different  abutments  suitable  for  fixed  bridges  can  be 
used.  The  attachment  consists  of  a  two-winged  curved  piece 
(Figure  185A),  into  which  fits  a  two-armed  anchor  (Figure 
185B).     The  curved  piece  is  called  a  keeper,  and  is  to  be  sold- 


A  B 

Fig.  185.     Morgan  attachments  for  removable  bridge. 

ered  to  the  gold  crown  abutment,  banded  crown  or  inlay  abut- 
ment. The  other  piece  is  called  the  anchor,  aiid  its  head  is 
curved  to  fit  into  the  keeper  Avith  a  cap  soldered  on  the  top,  the 
shank  passes  out  between  the  wings  of  the  keeper,  and  furnishes 
anchorage  in  the  gold,  or  other  material  of  Avhich  the  denture  is 
made. 

The  abutments  are  made  in  the  usual  manner:  place  them 
in  the  mouth,  take  impression  and  bite,  and  make  articulated 
model.  If  you  wish  to  avoid  taking  a  second  impression  and 
making  a  second  cast,  flow  a  thin  coating  of  wax  inside  the 
crown,  before  pouring  the  plaster  cast,  then  by  heating  the 
crowns  sufficiently  to  melt  the  wax,  these  can  be  slipped  off 
and  on  at  will,  and  the  one  impression  and  cast  will  do  the 
entire  work. 

To  adjust  a  keeper  to  each  of  the  abutments,  and  to  have 
both  perfectly  parallel  to  each  other,  tlie  originator  constructed 
a  jig.      (Figure  186. 


Fig.  186.     Jig  for  Morgan  attachments. 


REMO FABLE  BRIDGES 


Fasten  the  jilastcr  modd  t(»  tli<*  luisc  of  tlic  ji^  \)y  means  ol' 
the  thumbscrews. 

Slip  tlie  kee])(M-s  ovcj-  llic  forks  of  the  jij;,  Ix'iiij;-  careful  that 
tliey  are  put  on  evenly,  as  can  be  told  l)y  sightinj*  past  the  edjie 
of  both  to  see  if  the  edges  are  in  line  witli  each  other. 

Loosen  the  tlnmibscrew  on  tlie  nprijiht  bar,  and  lower  the 
keeper  to  the  ])]ace  beside  the  abiitiiieiits. 


dsi 


Fig.   187.     Morgan   attachments   soldered   to   all-metal   crowns. 

Wax  them  in  place  with  sticky  wax  and  when  cold  raise  the 
guide  forks  out  of  the  keepers.  Loosen  the  thumljscrews  and 
remove  the  model. 

Now  remove  the  crowns  from  the  cast,  and  wax  them  so 
that  no  plaster  can  come  betAveen  the  keeper  and  the  crown. 

Invest  with  that  end  of  the  croAvn  upwards,  which  makes  it 
most  convenient  for  soldering.  Make  sure  that  the  investment 
holds  the  parts  in  place,  and  that  the  curved  slot  in  the  keeper 
is  thoroughly  filled  with  investment.     Cut  the  investment  away 


Fig.  188.     Morgan  attachments  used  on  various  crowns. 


to  give  free  access  to  soldering,  boil  the  wax  out  and  solder. 
Should  the  keeper  stand  away  from  the  crown  at  one  end,  fill 
the  space  with  gold-foil,  so  as  to  assure  a  strong  joint  when  you 
solder. 


172 


CROWNS  AND   BRIDGES 


After  having  the  keeper  soldered  to  the  abutments,  fit  them 
in  the  mouth,  and  take  impression  and  bite  for  a  new  articu- 
lated model;  but  if  you  have  saved  your  first  cast  by  using  a 
wax  coating  in  the  abutments,  replace  the  abutments  to  the 
plaster  model. 

Making  of  the  supply 

As  described  for  Gilmore  bridges,  one  can  use  different  ma- 
terials to  supply  the  lost  teeth :  rubber  facings,  detached  post 
croAvns,  Steele  teeth,  Goslee  teeth,  and  others. 


Fig.   189.     Finished  case  of  Figure  187. 

Slip  the  anchor  over  the  keepers,  slipping  the  metal  loop 
which  comes  with  the  attachment  over  the  anchor's  sliank. 
Bend  the  latter  down  so  as  to  keep  it  as  much  out  of  the  way  as 


Fig.  190.     Saddle  with  single  Morgan  attachment. 

possible,  when  you  are  setting  up  the  teeth.  The  loop  is  fur- 
nished with  the  attachments,  and  allows  for  stronger  connec- 
tion of  the  anchor  with  the  supplies. 


REMOVABLE  BRIDGES 


173 


AVlien  all  the  supplies  are  waxed  up,  solder  the  bridge  in 
ordinary  manner,  makinii'  snre  to  .uet  a  j;ood  junction  Ix^wcen 
the  anchor-loop  and  tlie  gold  of  the  bridge.      In  case  of  a  saddb' 


Fig.  191.     Lower  denture  with  Morgan  attachments. 


bridge,  the  anchor  and  loop  can  also  be  soldered  to  the  saddle 
first.  The  illustrations  show  some  practical  cases.  (Figures 
189,  190,  191.) 


X.    REPAIR  OF  CROWNS 
AND  BRIDGES 


1.    FOR  TEMPORARY  USE 

Crowns  and  bridges  which  have  been  taken  off  can  be  re- 
paired for  temporary  use,  while  the  new  bridge  is  nnder  con- 
struction. There  is  no  need  for  the  patient  to  go  without  the 
crown  or  bridge  teeth,  as  it  is  a  simple  matter  to  fix  old  bridges 
so  that  they  will  fill  the  spaces  and  spare  the  patient  objection- 
able appearance.  For  example :  when  crowning  an  incisor  or 
bicuspid  tooth,  we  can  cut  the  tooth  off  close  to  the  gum,  with  a 
small  cross-cut  fissure  bur,  then  prepare  the  root  for  whatever 
crown  we  intend  to  use.  Instead  of  sending  the  patient  home 
toothless,  fit  a  temporary  tooth  or  crown,  such  as  shown  in  Fig- 
ure 192,  or  use  the  tooth  that  was  cut  off,  by  first  removing  all 
decay,  then  drilling  a  hole  for  a  german  silver  post.  Cement 
post  into  the  crown,  and  press  into  place  while  the  cement  is  still 
soft.  With  the  same  cement  fill  up  all  imperfections  of  the 
tooth  to  be  used.  When  the  cement  is  set,  remove  the  tooth 
with  post  and  sandpaper  the  edges    (Figure  192).     Now  dry 


Fig.  192.     Temporary  crowns. 


REPAIR  OF  CROfVNS  AND  BRIDGES 


175 


the  root,  put  in  tlie  di-essiiij^,  or  till  the  apex  of  tlie  root,  and 
then  set  tlie  erowu  with  temporary  stoj>piii<^-  or  soft  .livitta- 
percha. 

This  temporary  tooth  or  erowii  will  keep  the  ^viiii  from 
growing  over  the  root,  which  would  happen  if  the  root  would 
not  be  protected  with  a  covering.  If  for  any  reason  a  tooth  or 
crown  cannot  be  used  temporarily,  a  covering  can  be  con- 
structed of  german  silver  by  cutting  a  i)late  the  size  of  root 
almost  any  gauge  (from  20  to  30  gauge),  whatever  is  at  hand 
and  soldering  a  post  through  it.     Set  this  with  gutta-percha. 

A  gutta-percha  plug  can  also  be  used  for  this  purjiose,  as 
follows:  Shape  a  jjiece  of  pink  base  plate  gutta-percha  (coiic 
shape),  dry  the  root  and  force  it  into  the  canal  witli  a  suital)l( 
instrument.  When  the  point  is  firmly  held  in  the  canal,  i)res:- 
an  extending  ball  over  the  whole  surface  of  the  tooth.  In  re- 
gard to  replacing  old  bridges  for  tenqjorary  wear,  see  I'igures 
193  and  194.     The  post  of  the  cuspid  crown  was  cut  off  tlirougii 


Fig.  193.     Old  crowns  and  bridges  after  thev  have  been  taken  off. 


the  band  from  the  labial  side.  The  gold  crown  was  split  open 
from  the  palatal  side,  and  after  the  cuspid  and  molar  roots 
were  prepared  for  the  new  crowns,  the  old  bridge,  after  boiling 


176 


CROfFA^S  AND   BRIDGES 


it  in  acid,  and  a  new  x^ost  with  a  shoulder,  is  cemented  in  the 
cap  without  necessitating  the  drilling  of  a  hole  into  the  gold. 
While  the  cement  was  still  soft,  the  bridge  was  placed  into  the 
position  on  the  root.  After  the  cement  had  set,  the  bridge  was 
removed,  all  surplus  cement  taken  away,  and  after  drying  the 
cuspid  and  molar  roots  the  bridge  was  set  with  temporary  stop- 
ping. (The  split  of  the  molar  crown  was  only  drawn  together, 
and  burnished,  but  not  soldered.)      Figure  194  shows  two  gold 


Fig.   194.     Old  bridges   with  posts  cemented   into   crowns  and   used   temporarily 
till    new    bridges    were    constructed.     These    bridges    were    set    with    temporary 

stopping. 


crowns  with  cemented  pins,  both  teeth  having  been  cut  off.  It 
was  set  with  temporary  stopping,  with  post  cemented  in  bicus- 
pid gold  crowns,  and  used  temporarily  to  protect  the  roots,  dur- 
ing the  construction  of  new  bridge. 

Very  often  a  broken  post  of  a  Richmond  crown  can  be  re- 
placed without  soldering,  by  drilling  a  hole  into  the  bulk  of 
gold,  and  cementing  a  new  post  into  same  instead  of  soldering. 
The  principle  is  the  same  as  with  a  detached  post  crown. 


REPAIR  OF  CROWNS  AND  BRIDGES 


177 


2.     REPAIR  OF  GR(3WNS  AND   BRIDGES  FOR 
PERMANENT  USE 

Before  removing  a  crown  or  bridge  consider  \vliellier  you 
are  going  to  use  it  only  for  a  temporary  aijpliance,  till  the  ncAv 
bridge  is  made,  or  whether  yon  want  to  repair  it  for  jjermanent 
nse.  In  the  latter  case  you  want  to  be  careful  Avhen  cutting 
the  crowns,  so  as  to  make  the  repair  as  easy  as  fjossible.  All 
metal  crowns  are  best  cut  on  the  buccal  side,  while  banded  jjost 
crowns  can  be  removed  easily,  if  we  cut  from  the  lingual  side 
into  the  cap,  using  a  new  small  round  bur.  In  this  fashion, 
we  cut  off  the  post  from  the  cap  and  also  remove  \yAYt  of  the 
cement.  After  removing  the  bridge,  Ave  repair  the  all-metaj 
crowns  by  burnishing  them  in  place,  Avaxing  a  piece  of  plati- 
num foil  in  the  inside.  After  investing,  floAv  solder  over  the  cut 
part.  For  banded  croAvns,  fit  a  ucav  post,  which  extends 
through  sufficiently  far  to  get  the  relation,  wax  it  in  place  Avith 
sticky  Avax,  or  take  a  plaster  impression.  Invest  and  solder. 
To  cut  the  buccal  side  of  a  gold  crown,  try  your  wedge  cutter. 
It  does  it  better  than  most  crown  slitters. 

To  extract  a  broken  post  from  the  root  of  the  tooth,  one  can 
use  the  S.  S.  White's  post  extractor,  or  the  Giant  post  puller,  or 


Fig.  195.     S.  S.  White's  and  the  Giant  post  pullers. 

similar  device.  With  a  small  round  bur  cut  around  the  post 
till  there  is  sufficient  space  to  take  hold  of  it  with  one  of  the 
described  instruments.  A  post  can  also  be  removed  by  drilling 
with  a  new  No.  ^  round  bur,  around  the  post  dowuAvards,  along 
side  of  post,  stay  in  close  contact  with  the  post,  drilling  part 


178 


CROWNS  AND   BRIDGES 


of  the  post,  there  is  no  danger  in  perforating  the  root.  Should 
the  post  be  at  one  side  of  the  root,  one  can  easily  drill  down 
on  the  other,  finally  jjushing  it  to  the  side,  in  the  newly  drilled 
hole,  and  then  removing  it. 

Broken  Steele,  Goslee  teeth  or  facings  can  often  be  replaced 
without  taking  the  bridge  off.  To  repair  facings  we  have  the 
following  metliods : 

1.  Ash's  repair  outfit. 

2.  Steele  repair  outfit. 

3.  Bryant  repair  outfit. 

4.  Another  method. 


r~^  -^ 


83 


Fig.  196.     Ash   repair  facings. 


1.     ASH'S   REPAIR   FACINGS 

a.  If  a  pin  facing  is  broken  and  both  pins  (cross  pins)  arc 
left  in  the  backing,  simply  cement  a  repair  facing  on  as  de- 
scribed below. 

b.  If  one  pin  is  lu'oken,  the  other  remaining  in  the  backing, 
cut  off  the  standing  pin,  grind  the  backing  flat  with  a  small  car- 
borundum i^oint,  drill  a  liole  in  the  centre  of  the  backing  Avith 
the  Ash  rei)air  outfit,  remove  the  burred  edge  formed  by  the 
drill,  with  the  countersinking  tool,  tap  the  hole  with  the  small 
tap,  follow  on  with  the  large  tap,  again  clear  away  the  burred 


REPAIR  Of  CROfVNS  AND  BRIDGES 


179 


edge  with  the  countersinking  tool,  fix  the  Ash  stud  selected  in 
holder,  and  screw  it  into  position  rij^lit  up  to  tlie  shoulder. 

Select  a  repaii-  faciii''  of  llic  same  sv/At  as  the  brokeii-off 
tooth,  remove  all  traces  of  wax  from  it,  grind  it  to  place,  thor- 
oughly cleanse  it;  mix  crown  and  l)ri<lge  cement  to  a  thin 
creamy  consistency,  smear  the  backing  and  the  back  of  tlie  fac- 
ing with  it,  also  fill  up  the  undercuts  in  tlic  oval  cavity  of  tlie 
facing,  press  tlie  facing  to  place,  hold  it  tirmly  in  ])osition  for 
four  or  five  minutes,  then  trim  away  excess  of  cement,  and  coat 
the  exposed  edge  with  varnish.      (Figure  196.) 

2.     STEELE    REPAIR   OUTFIT 

Cut  off  the  projecting  pins,  and  stone  the  bridge  to  a  flat 
surface.  Tavo  holes  are  drilled  and  threaded  to  receive  the 
screws  provided  for  the  purpose.      (Ilgnre  19715. )    A  KSteele"s 


Fig.   197A.     Steele   repair   outfit. 


interchangeable  tooth  facing  is  then  placed  in  position  over  the 
heads  of  the  screws,  which  engage  the  hole  and  slot  in  the  fac- 
ing. Wlien  cemented,  all  fluids  are  excluded,  which  renders  it 
thoroughly  sanitary.      (See  Figure  197B.) 


180 


CROWNS   AND    BRIDGES 


7  8  9 

Fig.  197B.    Different    steps  to   repair  a  broken   pin   facing. 

3.     BRYANT   REPAIR   OUTFIT 

This  metliod  is  also  very  good.  The  repaired  tooth  is  fas- 
tened to  the  bridge  by  means  of  threaded  nuts.  The  method  is 
very  simple,  and  gives  a  strong  result.     (Figures  198A,  198B.) 


Fig.  198A. 


REPAIR  OF  CROfVNS  AND  BRIDGES 


181 


H   lJ  ^  Qi 


Fig.   198B.     Bryant  repair  outfit. 


n 


4.     ANOTHER    METHOD 

Cut  pins  even  with  backing.  Select  a  long  pin  facing  of 
proper  size,  flow  a  thin  layer  of  Avax  over  surface  of  the  backing. 

Press  facing  in  right  position  on  to  the  wax  against  the 
backing. 

Drill  the  holes  through  the  backings,  as  shown  by  the  im- 
print of  the  pins  on  the  wax. 

Grind  the  facing  to  the  backing,  or  take  an  impression, 
make  a  cement  model  and  grind  facing  to  that. 

If  the  backing  is  thick  enough,  as  it  is  often  the  case  in  cus- 
pids, Richmond  crowns,  bicuspid  and  molar  dummies,  the  ce- 
menting of  the  pins  and  facing  to  the  backing  is  sufdcient  to 
secure  a  good  hold. 

In  case  of  a  thin  gold  backing  and  close  bite,  the  position  of 
the  pins  to  the  bite  must  be  taken  into  consideration.  The  pins 
when  extending  through  the  backing  must  be  below  or  clear 
the  bite. 

Grind  and  cement  the  facing  into  place,  turn  the  pins  over 
on  the  other  side,  using  a  pair  of  flat  plate  pliers. 

If  the  pins  are  far  enough  apart,  it  is  best  to  have  them 
meet  ends  to  ends. 

Stone  the  pins,  dry  both  pins,  and  gold  surface  around  them, 
and  build  amalgam  into  and  around  the  pins. 

The  mercury  will  amalgamate  perfectly  with  the  gold. 

When  hard,  stone  and  polish. 


182 


CROWNS   AND   BRIDGES 


iMINERAL   STAINS 

To  get  the  effect  of  rhacliitic-lij'poplastic,  smokers',  and 
other  teeth,  grind  teeth  first  to  desired  shape,  then  use  the 
S.  S.  White  or  Ash  stains.  Mix  the  stains  with  oil  and  turpen- 
tine, and  apply  the  paint  to  the  tooth  with  a  fine  brush.  As 
the  color  does  not  change  in  the  firing-,  it  is  best  to  paint  and 
match  the  teeth  in  the  mouth,  when  tlie  patient  is  present. 
(Figure  199.) 


^^  /'^ 


A 


1 


^-^^ 


Fig.    199.     Mineral   stains   and   stained   teeth. 


SPECIAL   INSTRUMENTS 

1.     BRIDGE   METER 


This  instrument  is  used  for  measuring  distances,  and  is  in- 
dispensable for  paralleling  root  canals  and  lining  up  of  teeth. 

Many  bridges  are  built  and  could  not  be  set,  because  the 
teeth  or  roots  were  incorrectly  prepared  for  the  abutments. 


53 


w 


Ph 


184  CROWNS   AND   BRIDGES 


Yei'j  seldom  we  find  two  or  more  teeth  or  roots  in  the  mouth 
stand  parallel  to  one  another,  to  permit  a  bridge  with  good  fit- 
ting crowns  to  slide  in  place  rightly. 

This  instrument  is  of  great  value  for  measuring  the  dis- 
tances of  tooth  spaces,  also  length  and  thicknesses  of  teeth  in 
the  mouth,  as  well  as  on  the  work  model,  for  lining  up  of  inter- 
locking devices  on  fixed  or  removable  bridges,  and  in  many 
other  cases. 


XL    PRACTICAL  CASES 

CASE   I 

To  correct  iiial-occlusioii  in  the  adult  Avitli  bridgework  is  a 
more  difiQcult  problem  than  the  treatment  of  same  in  ortho 
dontia  in  the  early  age,  and  while  in  the  latter,  normal  occlu- 
sion can  almost  always  be  obtained,  we  usually  have  to  be  satis- 
fied in  bridgework  by  getting  sufficient  occlusion. 

Figure  202  shows  condition  of  the  mouth.  Figure  203  is 
radiographs  of  the  roots.  It  was  decided  to  extract  the  two 
upper  central  incisors,  right  lateral  and  the  right  upper  molar. 

Figures  202  to  211  shoAV  steps  for  making  of  Itridge. 


186 


CROWNS  AND   BRIDGES 


Fig.  204. 

Figure  204  shows  tlie  impression  of  the  abutments. 


Fig.  205. 
r'igure  205  is  the  plaster  model  with  the  abutments  in  place. 


PRACTICAL  CASES 


187 


Fig.  206. 
Figure  2())»  shows  tlic  articulated  UKxlids  \\\\\\  face  liow  rela- 
tion. 


Fig.  207.     Bridge  teeth  waxed   for  trial. 

Figure  207,  detaclied  post  crowus,  ground  in  position  and 
ready  for  trial  in  wax. 


!88 


CROWNS   AND    BRIDGES 


Fig.   208.     A,    showing   teeth   in  plaster   core   on   the   model.     B,    showing   teeth 
boxed,  ready  to  be  soldered  in  sections  of  two  and  four. 

Figure  208A  shows  the  crowns  held  in  plaster  core,  ready 
for  backing. 

Figure  208B  shows  the  crowns  boxed,  with  swaged  plati- 
num saddle  on  the  molars  in  position. 


A  B  C 

Fig.  209.     Sections  of  tooth  boxes,  invested  and   ready  for  soldering. 

Figure  209A,  invested  saddle  from  front;  B   from  back; 
C  invested  section  of  cast  boxes  of  front  teeth  ready  to  solder. 


PRACTICAL  CASES 


189 


Fig.  210.     Sections  united  to  abutments. 

Figure  210,  soldered  bridge,  top  and  bottom  view 


Fig.  211.     Finished  fixed  bridge  with  teeth  cemented  into  boxes. 

Figure  211,  finished  bridge,  teeth  cemented. 

CASE   II 

Case  II,  a  school  case,  shows  the  mouth  of  a  young  girl  of  18 
years,  with  only  six  permanent  teeth,  the  four  six-year  molars 


Fig.  212.     Harvard  Dental  School  case,  before  treatment. 


Fig.  213.     Same   case,   before   treatment. 


PRACTICAL  CASES 


191 


and  two  upper  central  incisors.     Figures  21'2  and  213  sliow  tlie 
case  before  treatment. 

Eadiograplis  revealed  absence  of  periiianciit  t<'('th  l)eneatli 
the  temporary  teetli  in  botli  javvs.      (Fionre  214. )     Radiograplis 


Fig.   214. 


show  absorption  of  roots  of  temporary  teeth,  with  the  exception 
of  the  cuspid;  same  condition  on  the  other  side  of  tlie  mouth. 


Fig.  215.     After  treatment. 


192 


CROfVNS  AND   BRIDGES 


Figure  215  shows  finished  case.  Upper  and  lower  fixed 
bridges  were  constructed.  In  the  upper  jaw  the  centrals  were 
pushed  forward  and  drawn  together,  and  two  laterals  attached 
to  same,  leaving  the  temporary  cuspids  and  molars  untouched. 


CASE  III 

A  pyorrhoea  case,  with  fixed  bridgework 
ment;  B,  after  treatment.      (Figure  216.) 


A,  before  treat- 


FiG.   216.     Pyorrhoea   case,  before   and   after   treatment. 


CASE  IV 

Patient  presented  a  closed  bite,  as  shown  in  Figure  217A 
and  219A.  The  incisors  were  worn  down  on  the  palatal  side. 
This  was  remedied  by  raising  the  bite  with  fixed  bridges.  (Fig- 
ures 217B  and  219B.  The  incisors  received  gold  inlays 
Avithout  removing  the  pulps.  Kadiograph  (Figure  218)  shows 
the  condition  of  the  pulps  after  seven  years. 


Fig.   218.     Cast   inlays   for   Fig.   217. 


A  B 

Fig.  219.     Before  and  after  treatment. 


194 


CROWNS  AND   BRIDGES 


CASE  V 

The  patient's  lower  teeth  were  protruding  (Figure  220A) 
Radiograph   (Figure  220B)   shows  direction  of  roots. 


Fig.   220.     Before   treatment ;    model   and    radiograph. 

Figure  221  shows  the  frame  with  platinum  caps  and  posts. 
The  centrals  and  lateral  caps  were  soldered  to  the  wire,  while 
the  two  cuspids  were  fastened  by  a  loop  to  permit  the  swing- 
ing of  caps  and  posts  towards  the  median  line  to  accommodate 
the  ano;le  of  their  roots. 


Fig.  221.       Bridge   frame. 


PRACTICAL  CASES 


195 


Fig.  222A. 


Figure  222A  shows  the  frame  on  the  model,  Figure  222B 
radiograph  of  frame  on  the  roots. 


Fig.  222B. 


196 


CROWNS  AND   BRIDGES 


Figure  223  shows  upright  position  of  the  artificial  teeth. 


Fig.    223.     Cases    like   this    in    rubber   must    be    strengthened    from   bicuspid    to 

bicuspid   as   otherwise   the   plate   will   break    easily.     The    gold    frame   takes    up 

much   space  and  weakens  such  a   plate  in   front. 

Figure  224,  the  case  flasked. 


A  B 

Fig.  224.     A,  Gold  bar  in  place  to  strengthen  plate.     B,  Attachments   in  place. 


PRACTICAL  CASES 


197 


Note. — There  are  two  Gilmore  attncliiiM^iits  Ijeliind  tlie  cus- 
pids in  224R,  and  the  strong;:  platinized  gold  l>ar  in  the  other 
half  of  the  flask  (Figure  224A).  This  gold  bar  is  necessary, 
as  rubber  plates  of  this  type  are  weak  in  front. 


CASE   VI 

Two  crowns  to  show  how  to  overcome  a  wide  space  of  the 
median  line. 

A,  showing  the  front;  L>,  the  back  of  two  central  crowns  (a 
practical  case).  These  crowns,  one  a  Richmond,  the  other  a 
banded  porcelain  crown,  filled  the  big  space  that  was  between 
the  central  roots,  and  gave  satisfaction  to  the  patients  for  many 
years. 


Fig.  225.     Extra  wide  crowns  to  fill  space  of  median  line. 

CASE  VII 

PORCELAIN    ROOT   DUMMIES 

Supplies  with  porcelain  roots  give  good  satisfaction  to  the 
patient  and  operator.     Figure  226  shows  right  side  superior 


Fig.  226.     Model   showing  effect   of   lateral    tooth    dummy   with   porcelain    root 

after   six   years. 


198 


CROWNS  AND   BRIDGES 


Fig.  227.     Radiograph   of   same  case. 

bridge;  the  bicuspid  and  cuspid  roots  carry  Riclimond  crowns, 
witli  lateral  dummy  attached.  The  lateral  dummy  with  a 
porcelain  root  shows  after  six  years  no  irritation,  or  absorption 
of  gum,  as  shown  in  Figures  226  and  227.  The  operation  is  as 
follows : 

Take  a  radiograph  of  the  teeth  involved  in  the  bridge. 

Take  a  plaster  impression  and  bite. 

Make  an  articulated  model. 

Cut  away  the  plaster  tooth  and  carve  (with  the  aid  of  the 
radiograph)  the  depth  of  the  root  in  the  model. 

Shellac  model,  carve  a  facing  or  slotted  tooth  with  root, 
(Figure  228),  using  high  fusing  porcelain  body. 


.V' 


A  B 

Fig.  228.     A,   slotted  porcelain  tooth  with  root.     B,  pin  facing  with  root. 

Finish  the  abutments  next  to  the  tooth  or  teeth  that  are  to 
be  extracted,  and  to  be  replaced  with  porcelain  root  dummies 
first. 


PRACTICAL  CASES 


199 


Then  take  a  wax  1)ite  and  ])]aster  ]'iii])i-('ssi(»i). 
Now  extract  the  bad  tooth,  and  place  it,  with  the  abutments, 
into  the  plaster  impression. 


Fig.  229.     Fractured   lateral   root  and   crown. 

In  case  of  a  split  root  often  caused  by  a  post  crown  (Figure 
226),  put  this  post  crown  back  on  to  the  extracted  split  root, 
and  put  this  with  the  bridge  abutments  back  into  the  plaster 
impression. 


> 


Fig.   230.     Gold   inlay,   with   post    carrying   lateral    dummy   with   porcelain    root 

as  per  Figure  223A. 


200 


CROWNS  AND   BRIDGES 


Make  articulated  model. 

Eeniove  from  the  model  the  extracted  tooth  or  split  root. 

Fit  into  the  socket  a  hand-carved  porcelain  root  clnmm}'. 
(Figure  228.) 

Fit  a  gold  backing  to  facing  (Figure  228A),  or  gold  box 
with  post  to  slotted  tooth  (Figure  228B)  ;  wax  same  to  the 
abutments. 

Invest,  solder  and  finish  in  the  usual  way. 

The  bridge  should  be  finished  and  set  the  same  day  when 
the  root  is  extracted,  as  this  will  facilitate  the  placing  of  the 
porcelain  root.  The  porcelain  is  received  very  favorably  by 
the  tissue,  and  therefore  no  inflammation  and  absorption  is  ex- 
perienced. 


CASE  VI I  r 

FULL   UPPER— FIXED   BRIDGE 


Fig.   231.     Crown   and    Bridge   Case    VIII,   before   treatment. 
Showing  a   closed  bite   due  to   poor  bridge   construction.     These  bridges   were 
made  without  chewing  surfaces    (see  Fig.  232),  allowing  the  bite  to  close,  forc- 
ing the  bridges  apart  and  thereby  loosening  the  bridge  abutments. 


PRACTICAL  CASES 


201 


Fig.  232.     Crown  and  Bridge  Case  VII T,  l)efore  treatment. 

The   left    superior   bridge    is    supported   by   the   cuspid   and   molar.        The    right 
superior  bridge  by  the  two  laterals  and  molar. 


Fig.  233.     Crown  and  Bridge  Case  VIII,  after  treatment. 

Showing  the  new  bridge  with  raised  bite  under  construction.  At  tliig  stage  the 
bridge  is  shown  ready  for  the  final  assembling  of  the  three  parts :  lateral  to 
lateral  and  cuspid  to  molar  for  each  side.  When  soldered  to  the  three  root 
caps  with  posts  and  the  two  all-metal  molar  crowns  this  will  complete  a  full 
upper  fixed  bridge.  Facings  and  Steele  Posteriors  in  gold  boxes  were  used  for 
dummies  with  two  close  bite  gold  cusps  on  the  left  bicuspids.  These  cusps  had 
to  be  used  to  overcome  the  close  bite  in  that  region,  and  were  constructed  as 

shown  in  Fig.   124B. 


202 


CROWNS  AND  BRIDGES 


CASE  IX 

FIXED   BRIDGES 


Fig.  234.     Crown  and  Bridge  Case  IX,  before  treatment. 


Fig.  235.     Crown  and  Bridge  Case  IX,  after  treatment. 


PRACTICAL  CASES 


203 


Fig.  236.     Crown   and   Bridge   Case   IX. 
Showing  the  lower,  before  treatment. 


Fig.  237.     Crown  and  Bridge  Case  IX. 
Showing  the  lower,  after  treatment,  with  two  sanitary  bridges. 


204 


CROWNS  AND  BRIDGES 


Fig.  238.     Crown  and  Bridge  Case  IX. 
Showing  the  upper,  before  treatment. 


Fig.  239.     Crown  and  Bridge  Case  IX. 

Showing  the   upper  after   treatment,   with   four  anterior   porcelain   crowns   anc 
two  cuspid  to  molar  self-cleansing  bridges. 


PRACnCAL  CASES 


205 


Fig.  240.     Crown  and  Bridge  Case  IX,  before  treat 


ment. 


Fig.  241.     Crown  and  Bridge  Case  IX,  after  treatment. 


206 


CROWNS  AND  BRIDGES 


CASE  X 

FlXliD   BRIDGES 


Fig.  242.     Crown  and  Bridge  Case  X,  before  treatment. 


Fig.  243.     Crown  and  Bridge  Case  X,  after  treatment. 


PRACTICAL  CASES 


207 


i'  Fig.  244.     Crown  and  Bridge  Case  X,  before  treatment. 


Fig.  245.     Crown  and  Bridge  Case  X,  after  treatment. 


208 


CROWNS  AND  BRIDGES 


Fig.  246.     Crown  and  Bridge  Case  X,  before  treatment. 


Fig.  247.     Crown  and  Bridge  Case  X,  after  treatment. 

Showing  lower  sanitary  bridge  with  porcelain  tooth  dummy  in  box,  carried  by 
a  biscuspid  and  molar  gold  inlay  with  post  abutments. 


PRJCTICAL  CIS  US 


209 


Fig.  248.     Crown  and  Bridge  Case  X,  before  treatment. 

Showing  a  molar  dummy  carried  by  an  all-metal  bicuspid  and  molar  crown.   The 

dununy  is  short  and  sets  in  to  accommodate  the  elongated  lower  six-year  molar. 

Compare  this  with  Fig.  242. 


Fig.  249.     Crown  and  Bridge  Case  X,  after  treatment. 

The  lower  six-year  molar  cut  down  and  finished  on  top  with  a  porcelain  inlay. 
The  upper  bridge  is  constructed  of  three  Davis  l)icuspid  crown  type  porcelain 
teeth,  carried  by  the  first  bicuspid  root  with  a  platinum  cap  and  post  and  an  all- 
metal  molar  crown.     The  mesial  corner  of  the  cuspid  is  built  out  with  porcelain. 


210 


CROWNS  AND  BRIDGES 


CASE  XI 

FIXED    BRIDGES 


Fig.  250.     Crown  and  Bridge  Case  XI,  before  treatment. 
Showing  close  bite. 


Fig.  251.     Crown  and  Bridge  Case  XI,  after  treatment. 
Showing   raised  bite. 


PRA  C  TI CA  L  CA  SES 


211 


Fig.  252.     Crown  and  Bridge  Case  XI,  after  treatment. 
Showing  bridge  in  place. 


Fig.  253.     Crown  and  Bridge  Case  XI,  after  treatment. 
Showing  bridge  in  place. 


212 


CROWNS  AND  BRIDGES 


Fig.  254.     Crown  and  Bridge  Case  XI,  after  treatment. 
Finished  case. 


PRACTICAL  CASES 


213 


CASE  XII 

FIXED    BRIDGES 


Fig.  255.     Crown  and  Bridge  Case  XII,  before  treatment. 


Fig.  256.     Crown  and  Bridge  Case  XII,  after  treatment. 
Showing  bridges  with  porcelain  teeth  in  boxes  in  place. 


214  CROWNS  AND   BRIDGES 


CASE  XIII 

FIXED   UPPER   AND   REMOVABLE   LOWER   BRIDGES 


Fig.  257.     Crown  and  Bridge  Case  XIII,  before  treatment. 
The  central  and  laterals  are  badly  affected  by  pyorrhoea. 


Fig.  258.     Crown  and  Bridge  Case  XIII,  after  treatment. 
With  a  fixed  bridge  in  place. 


PR.ICTICAL  CASES 


215 


Fig.  259.     Crown  and  Bridge  Case  XIII, 
Note  the  amount  of  tissue  lost  on  the  labial  side  between  the  cuspids. 


Fig.  260.     Crown  and  Bridge  Case  XIII. 

The   lost  tissue   between   the  cuspids  has  Ijecn   replaced  by  two  porcelain  gum 
blocks   (stock  teeth)    with  double  backings  soldered  to  the  adjoining  Richmond 

crowns. 


216 


CROWNS  AND   BRIDGES 


F^G.  261.     Crown  and  Bridge  Case  XIII,  before  treatment. 
The  last  lower  molar  on  the  left  side  was  badly  abscessed. 


P^ 

^ 

^^m            .ail^fc^^ 

^   M 

Fig.  262.     Crown  and  Bridge  Case  XIII,  after  treatment. 
Showing  removable  bridge  in  place. 


PRACTICAL  CASES 


217 


^^^^^^^T^^^^^^ 

i^V| 

WT  m 

""^^l 

^^  ■ 

■    V 

^^J 

Fig.  263.     Crown  and  Bridge  Case  XIII. 
Showing  gold  frame  in  place. 


Fig.  264.     Crown  and  Bridge  Case  XIII. 

Showing  under  side  of  the  removable  lower  bridge  with   two   Gihnore  attach- 
ments in  place. 


218 


CROWNS   AND   BRIDGES 


Fig.  265.     Crown  and  Bridge  Case  XIII,  before  treatment. 
Pencil  marks  on  model  show  teeth  to  be  extracted. 


Fig  266.     Crown  and  Bridge  Case  XIII,  after  treatment. 
With  the  upper  fixed  bridge  and  lower  removable  bridge  in  place. 


INDEX 


Acid  mouth,  15 
Adjustments,  76 
Advice,  operator's,   12 
After-effects,  59 
All-porcelain  crowns,  78 
Anaemia   (deep),  48 
Anaesthesia,  Oral,  44 
Ash's  bridge  sj^stem,  145 
Ash  repair  facings,  178 

outfit,  178 
Attachment,  dove-tail,  144 

Gilmore,   146 

Morgan,  169 

Roach,  168 


Bridges,  assembling,  137 

extension,  160 

fixed,  119 

full,  156 

Morgan  attachments,  169 

removable,  144-218 

removable,    with    Gilmore    at- 
tachments, 145 

Roach  attachments,  168 

short,  158 

with  lingual  bar,  160 

with  vault  bar,   158 
Building  up   decayed   or  broken  down 

teeth,  43 
Burnished  caps,  banded  abutments,  122 
banded  crowns,  95 


B 

Backing  of  teeth,  64 

Banded   crown   abutments,    122 

Banded  crowns,   92 

Base  for  banded  abutments,   122 

crowns,  93 
Box   for  Goslee  tooth,  99 
Bridge  cases,  classification,   13 

case  on  articulator,  63 

extensions,  144 

gold  chewing  surface,  138 

Goslee  teeth,   136 

individual  saddles,  143 

interlocking,  144 

porcelain  saddle,  142 

repairs,  174,  180 

sanitary,  137 

self-cleansing,   138 

study  of  cases,  11 

with  continuous  saddle,  140 
Bridge  work,  abutments  for  fixed,  119 
supplies,    126 


Care  of  bridges,  ^^ 

Cases,  normal  and  abnormal,  48 

Cast  cusps,   107-126 

Casting,  70 

Cast  supplies,  127 

Cementing,  75 

Cement  for  setting  crown,  124,  126 

Chewing  surface,  gold,  137 

porcelain,  138 
Classification,  13 
Closed  bite,  27 
Conductive   method,    54 
Crowns,  all  metal,  102 

detached  post,  81 

hand  carved,  81 

half,  with  post,  123 

jacket,  78 

open- face   (glove  fit),  102 

porcelain,   backed    with    plati- 
num base,  88 

porcelain,  with  burnished  cap, 
direct  method,  95 


220 


INDEX 


Crowns,  porcelain,  with  cast  base,  89 

cast    base,    direct    method, 

89 
cast  base,  indirect  method, 

90 
detached  post  crowns,  98 
facings,  97 
Goslee  teeth,  100 
soldered  cap,  direct  meth- 
od,  93 
Steele  teeth,  101 
swaged  cap,  indirect  meth- 
od,  96 
Crowns,  seamless  pressed,  108 
cast  cusps,  107 
Evslin  teeth,  136 
facing  soldered  in,  118 
Morgan  attachments,  171 
Roach  attachments,  168 
seamless  swaged,  113 
staple,   124 
stock,  82 

swaged  cusps,  106 
temporary,  174 
to    fill    wide    space    of    median 

line,  197 
two-piece,  105 
two-piece,  all  metal,   105 
Cusps,  swaged,  126 

D 

Deep  anaemia,  48 

Dentin,  treatment  for  hypersensitive,  60 

Detached  post  crown,  81-130 

Devitalization,  37 

Direct  method,  burnished  caps,  93 
cast  base,  89 
soldered  caps,  93 

Double  backings,  128 

Dovetail  attachment,  144 

Drugs,  41 

Dummies,     supplies     for     bridgework, 
126-197 


Effects,  after-,  59 
Evslin  teeth,  136 

bridge  meter,  183 


Examination,   11 

Exodontia,  37 

Extension  bridges,  144-160 


Face,  harmony  of  the,  29 

Facings,  67,  97-118,   126 

Fear,  59 

File  method  for  root  preparation,  83 

Files,  root,  86 

Fillings,  contour,  22 

Final    adjusting    crowns    and    bridges, 

76 
Fischer  syringes,  44 
Fitting  gutta-percha  base,  85 
Fixed  bridges,   119,  185,   189,   192,  194, 

197,  200,  202,  206,  210 
Foundation,  9 
Forced  out  of  line,  30 
Fractured   root,   199 

G 

Gold,  72 

Gold,  Alexander,  68 

backings,   66 
Gold  casting,  70 

crowns,  102-113 

filling  contour,  22 

foil,  67 

plate,  93 

plating,  73 

plating  outfit,  74 

platinized  wire,  147 

solder,  67 
Grinding  porcelain  teeth,  64.  187 
Gum  blocks,  19,  215 
Gutta-percha  base,  85 

H 

Harvard   Dental   School   cases,  31,   189 
Heat  the  case,  68 
Hypersensitive   dentin,   60 

I 

Inlay  abutments,  119 
M.O.D.,    119 
with  posts,  119 


IXDEX 


22\ 


Injcctiiiii,   lUiccinator,   57 

labial  side  ui  lower  incisors,  52 

infra-orl,ital,   58 

incisive,    58 

palatal  and  linj4ual  sides,  52 

post  palatine,  59 

Pterygo-mandibular,  54 

side  of  maxillary  teeth,  51 

Zygomatic,  57 
Instruction  to  patients,  76 
Tnstnimentarium,  44 
Inter-locking  two-piccc  bridges,  114 
Introduction,  9 
Irregular  teetli.  .33 


N 
Xcedle,  49 
Neothesin,   60 
Nerve,  Buccinator,  57 
Nerves,  posterior  superior  alveolar,  58 
Normal  occlusion,  20 
Novocain,  47 


O 


Occlusion,  20 
Open-face  crown,  102 
Oral  anaesthesia,  44 


Jacket  crown,   78 
Jar  for  syringe,  45 
Jaw,  lower,  51 

K 

Knowledge  received,  10 


Lack  of  contact  points,  22 

Lateral,    porcelain    dummy    with    root, 

198 
Local  anaesthesia,  44 

M 

Mal-occlusion,  21 
Mandibular  protrusion,  29 
Manipulation,   general,  61 
Maxillary  injection,  51 

protrusion,  29 
Metal  abutments,  123 
Method  facing  repairs,  another,  182 
Methods,  direct,  89,  93 

indirect,  89,  96 
Mineral  stains,  182 
Models,  12 

Mouths,  treatment  of,  37 
Morgan  attachments,  169 
Mounting   crown    and   bridge   case    on 
articulator,  63 


Pathological  conditions,   13 
Pieso's,  145 

Plating  bridges  with  pure  gold,  73 
Platinum  plate,  88 

post,  half-crown,  123 

saddle,  144 

staple,  124 
Polishing,  72 
Porcelain  crowns,  78,  90 
Position  of  operator,  84 
Posterior  Goslee  teeth,  135 
Steele  teeth,  131 
Post  fitting  to  root,  83 

with  inlays,  119,  120 
Post-palatine  injection,  59 
Posts,  Davis  straight  and  offset  centre, 

87 
Preliminary  treatment,  37 
Preparing  for  insertion,  49 
Prophylactic  treatment,  37 
Pterygo-mandibular  injection,  54 
Pulp  removal,   52,   59 
Pyorrhoeatic  conditions,  15 
Pyorrhoea  treatment,  37 

R 

Replaceable  crowns,  Goslee,  135 

facings,  101,  136 
Removable  bridge,   145 

Gilmore     attachment, 
145-160,  214-218 

Roach  attachments,  168 


222 


INDEX 


Removable  bridge,       Morgan      attach 

ments,   169 
Repair  bridges,  174,  180 

facings,  Ash,  179 
Richmond  crown,  93,  97 
Root,  impression  of,  96 
preparation,   93 
porcelain,   198 


Saddle  bridges,   140 

with  continuous  saddle,  140 
extension  with  saddle,  144 
with  individual  saddle,  143 
with  porcelain  saddle,  142 
with   removable   saddle,  145, 
169 

Sanitary  bridges,  137 

Seamless  crowns,   102 

pressed,  108 
swaged,   113 

Self-cleansing  bridges,  138 

Selecting  teeth,  64 
shade,  61 

Septic  roots,  13 

Soldering,  69 

Soldering  bridge  in  sections,  69 

Soldered  caps,  93 

Special  instruments,  182 

Split  root,  199 

Staple  crown,  124 

Steele    posterior,  131 

Steele  repair  outfit,  179 

Steele  teeth,  101 

Supplies  for  banded  crowns,  97 

Swaged  caps,  96 

Swaged  cusps,  106 

Syringes,  46 


Tablets  of  Novocain,  47 
Taggart  wax,  120 
Taking  bite,  61 

impression,   61 
Technical  manipulation,  61 
Teeth,  condition  of,  13 

elongated,  24 

Evslin,  136 

Goslee,  100 

irregularly  arranged,  Zi 

Steele,    101 

tipped  forward,  22 

temporary   retained,   26 

treatment  of,  37 

wandering,  30 
Treatment    for    hypersensitive   dentine, 
60 

U 

Use  of  Amalgam,  43 
Antiflux,  131 
bridge  meter,  183 
bridge  repair  tools,   180 
stains,  182 
s wager,  111,  134 

V 

Vulcanite  rubber,  60 

W 

Wax,  Taggert's,  Kerr's,  120 
Window  or  open-face  crown,  104 
With  cast  cusps,  107 

detached  post  crown,  98,  122 

facings,  97,  122 

gold  chewing  surface,   137 

Goslee  teeth,  100,  122 

porcelain  chewing  surface,  138 

Steele  teeth,  101,  122 

swaged  cusps,  106 


LIST  OF  ILLUSTRATIONS 


FIG.  PAGE 

1.  Radiographs    showing    perforalion    of    roots    with    posts    extending 

through    same 11 

2.  Model  and  radiograph  of  distal  root  of  a  six-year  molar  carrying  a 

crown   with    extension 14 

3.  Radiograph  showing  pathological  conditions  of  the  teeth   ....  14 

4.  Radiograph  showing  pyorrhoeatic  conditions  of  the   roots  ....  15 

5.  Bridge    splint 16 

6.  Radiograph  of  bridge  splint  in  place   ....          17 

7.  Lower  bridge  of  two  open-face  crowns  with   gum  block    ....  19 

8.  Two  bridges  with  gum  blocks 19 

9.  Plain   and   gum   teeth 19 

10.  Bridge  case  with  normal  occlusion 20 

11.  Two  models   showing   sufficient  occlusion 21 

12.  Mal-occlusion.     Before   and   after   treatment 21 

13.  Mal-occlusion.     Model 22 

14.  Mal-occlusion.     Model 23 

15.  Radiographs  showing  lack  of  contact  points.     Before  and  after  treat- 

ment          23 

16.  Radiograph  showing  contact  points  restored  b}-  crowns 23 

17.  Mal-occlusion.     Molar  tipped   forward 24 

18.  Mal-occlusion.     Bridge  with  inter-locking  device 24 

19.  Mal-occlusion.     Bridge  with  inlay  abutments 25 

20.  Mal-occlusion.     Upper  bicuspid  is  elongated  caused  by  loss  of  lower 

teeth 25 

21.  Radiograph.     Right  lateral  incisor  a  temporary  tooth 26 

22.  Radiograph  showing  absorption  of  the  roots  of  two  temporary  teeth  26 

23.  Showing  unerupted  cuspids  under  bridges 2/ 

24.  Mal-occlusion,  closed  bite.     Bite  has   closed   to   such   an   extent,   the 

upper  incisors  have  worn  down 27 


224  LIST  OF  ILLUSTRATIONS 


FIG.  PAGE 

25.  Mal-occlusion,   closed  bite,  lower  jaw.     Before  and  after   treatment  28 

26.  Mal-occlusion,  closed  bite.     Front  view 28 

27.  Mal-occlusion,   closed  bite.     Left  side  views   show  conditions  before 

and   after   restoration 29 

28.  Mal-occlusion,  closed  bite.     Right  side  of  same  case 29 

29.  Mal-occlusion.     Incisors  pushed  out  on  account  of  closing  bite   .      .  30 

30.  Mal-occlusion,  mandibular  protrusion 31 

31.  Mal-occlusion,  maxillary  protrusion 32 

32.  Mal-occlusion,  upper  incisors  are   projecting 32 

2>2).     Mal-occlusion,    wandering   teeth 33 

34.  Mal-occlusion.     Spreading  of  the  two  central  incisors 34 

35.  Mal-occlusion.     A  shows  the  position  of  the  upper  lateral  and  cuspid  34 

36.  Mal-occlusion.     One  lateral   incisor  absent,   front  teeth   of  irregular 

length 35 

2)7.     Mal-occlusion.     Case   with   very   irregular   teeth 35 

38.  Radiographs  showing  cases  where  teeth  have  been  crowned  without 

devitalizing  the  pulps 38 

39.  Radiographs  showing  chronic  abscesses  on  roots  of  upper  teeth,  used 

as  abutments,  root  canals  not  having  been  properly  filled  ...  39 

40.  Radiographs    showing    chronic    abscesses    on    roots    of    lower    teeth  39 

41.  Series  of  radiographs   showing  treatment  and  filling  of  root  canals 

of  teeth  to  be  used  as  bridge  abutments 40 

42.  Radiograph  of  second  bicuspid  and  first  molar  with  chronic  abscesses  41 

43.  Showing  bent  root  of  a  lower  second  bicuspid 41 

44.  Radiographs   of   receded   pulps   and   constricted   chambers,    found   in 

advanced    age 42 

45.  Radiographs   showing  large  pulp  chambers,  found  in  young  teeth    .  42 

46.  Radiographs  showing  abnormal  branching  of  root  canals   ....  42 

47.  Instruments  for  local  anaesthesia 45 

48.  Syringes 46 

49.  Large  and  small  dissolving  cups 46 

50.  Skulls  showing  the  small  foramina  in  the  alveolar  process       ...  50 

51.  Position  of  the  operator  when  injecting 51 

52.  Radiograph  showing  the  infiltration  method  for  an  upper  cuspid  .      .  52 


LIST  (Jf  ILLUSTRJTIOXS  225 


FIG.  I'AGE 

53.  Horizontal  section  through  iunnan  head 53 

54.  Technique  of  inserting  needle  for  ptcrygo-mandiljular  injection   .      .  55 

55.  Sulcus  mandihularis  with  needle 56 

56.  Photograph  showing  posterior  superior  alveolar  branches   ....  57 

57.  Palate  of  an  adult .      .  58 

58.  Plaster  impressions  after  washing  trays  and  broken  pieces  with  hot 

water 62 

59.  Plaster  impressions  after  pieces  are  put  back  in   place  and  held  by 

sticky  wa.x 62 

60.  Plaster  impressions  after  casting,   showing  how  impression  was  cut 

in  mouth 62 

61.  Case  mounted  on  anatomical  articulator  by  means  of  a  face  bow  .      .  64 

62.  Facings  with   single  and   double  backings 65 

63.  Soldering  two  backings  in  the  flame 66 

64.  Showing  a  Goslee  tooth  saddle  bridge  invested  ready  to  solder   .      .  68 

65.  Showing  a  full  upper  bridge 69 

66.  Gold-plating  outfit  of  simple  construction 74 

67A,  67B,  67C.     Steps  for  jacket  crown 80 

68.     File  methods  for  root  preparation 83 

69A,   69B.     Position   of   operator   filing   a   left    upper   bicuspid    root    and 

a  lower  incisor  root 84 

70.  Detached  post  crown  with  gutta-percha  washer 85 

71.  A  root  file,  also  a  toothbrush  handle  with  root-file  grooves   ...  86 

72.  Root  preparation  for  detached  post  crown          87 

73.  Shows   straight  and  offset  centre  post 87 

74.  Steps  for  making  porcelain  baked  crown,  platinum  base       ....  88 

75.  Porcelain  crown  with  cast  base.     Direct  method 90 

76.  Porcelain  crown  with  cast  base.     Indirect  method 91 

77.  Steps  for  making  band  for  soldered  cap 93 

78.  Fitting  of  top  to  band  and  soldering  post 94 

79.  Dr.  Hovestadt's  special  plate  punch 94 

80.  Shows  the  use  of  plate  punch 94 

81.  Hand  Inirnished  top  with  post.     Finished  crown 95 

82.  .Steps  showing  the  making  of  swaged  root  caps 96 


226  LIST  OF  ILLUSTRATIONS 

FIG.  PAGE 

83.  Banded  crown  with  facing 98 

84.  Soldered  cap  with  detached  post  crown 98 

85.  Swaged  cap  and  box  with  detached  post  crown 99 

86.  Banded  crown  with  Goslee  tooth 100 

87.  Banded  crowns  with  Steele  facings .  101 

88.  Steps  for  seamless  open-face  crowns   (glove  fit) 102 

89.  Die   with   handle 103 

90.  Steps  continued  for  open-face  crown   (glove  fit) 104 

91.  Steps  for  two-piece  all-metal  crown,  swaged  cusps 105 

92.  Steps  for  two-piece  all-metal  crown,  cast  cusps 107 

93.  Steps  continued  from  Figure  92 107 

94.  Taking  bite  with  copper  band  in  position 108 

95.  Crown  contoured  to  copper  band .  108 

96.  Shows  split  tray  with  moldine  to  take  impression  of  crown   .      .      .  109 

97.  Split  tray  in  position 109 

98.  Tray  after  removal  and  closed 110 

99.  Metal  die  and  shell 110 

100.  Wooden  blocks  showing"  imprints  of  metal   die  and   swager   .      .      .  110 

101.  Diagram   of   swager ..Ill 

102.  Swaging  of  crown  over  die  into  wood  block 112 

103.  Melting  out  the  metal  from  the  crown 112 

104.  Finished   crown 113 

105.  Seamless  all-metal   crown.     Bridge  method.     Impression  with  bands  114 

106.  Bands  on  articulated   model 114 

107.  Crowns  contoured  and   articulated 114 

108.  Ready  to  cast 114 

109.  Casting  to  die .  115 

110.  Building  fusible  metal  to  edge  of  bands '    .      .      .  115 

111.  Knocking  off  metal  from  ring 116 

112.  Splitting  of  die 116 

113.  Pressing  of  seamelss  shell 117 

114.  Shows  marking  of  swaged  crown  to  conform  to  cervical  margin,  de- 

termined by  trial  band 117 


LIST  or  ILIA'STRAI'KJXS  227 


FIG.  i'AGK 

115.  Shows  curved  scissors  for  Iriniming  crowns  and  l)ands       ....  117 

116.  Steps  for  crowns  with  porcelain  facing 118 

117.  Tooth  preparations  for  inlay  abutments 120 

118.  Steps  for  bridge  with  inlay  abutments 12'i 

119.  Half-crown  with   post 123 

120.  Steps  for  making  staple  crowns 125 

121.  Model  on  articlator  for  cast  supplies 127 

122.  Supplies  before  and  after  casting 127 

123.  Facings  with  single  and  double  backings 128 

124.  Facings  with  swaged  cusps 129 

125.  Bridge  with  supplies  of  anterior  Steele  teeth 130 

126.  Steps  for  making  Steele  anterior  crown 131 

127.  Steele   anti-flux 131 

128.  Painting  of  backing  with  Steele  anti-flux 132 

129.  Right  and  wrong  way  of  filing  backings 132 

130.  Filing  to  remove  obstructions '.      .      .  132 

131.  Bridges  with  Steele  posteriors 132 

132.  Soldering   extension   to  backing 133 

133.  Fitting  to  tooth 133 

134.  Steps  for  making  box  for   Steele  posteriors 133 

135.  Bridge  with  short  teeth  and  short  gold  crown  abutments   ....  133 

136.  Steele  posterior  molar  with  slice  cut  from  the  distal  side   ....  134 

137.  Bridge  with  wash  space  and  freedom  of  festoon  next  to  crown  abut- 

ments and  dummies 134 

138.  Anterior  and  posterior  Goslee  teeth 135 

139.  Steps  to  show  making  of  boxes  for  Goslee  teeth,  or  other  porcelain 

crowns '    .      .      .      .  135 

140.  Anterior  Goslee  bridge : 136 

141.  Posterior  Goslee  bridge 136 

142.  Evslin  interchangeable  teeth  for  crown  and  bridge  work   ....  136 

143.  Soldering  of  casting  to  all  metal  abutments 137 

144.  Top  view   of  sanitary  bridge :      .      .      .  137 

145.  Sanitary   bridge   with   gold    casting 137 


228 


LIST  OF  ILLUSTRATIONS 


FIG.  i'AGE 

146.  Sanitary  bridge  with  porcelain  chewing  surface 138 

147.  Self-cleansing  bridge  showing  wash  spaces   ...          140 

148.  Saddle  bridge.     Teeth  in  core  before  boxing 141 

149.  Saddle  bridge.     Teeth  boxed 141 

150.  Saddle  and  boxes  invested  ready  for   solder 141 

151.  Saddle  bridge,  before  and  after  cementing  supplies 142 

152.  Shows  a  banded  porcelain  molar  crown  and  bicuspid  dummy       .      .  142 

153.  Hand-carved   porcelain  blocks   with  porcelain   saddles 143 

154.  Extension  bridge  from  front  and  back 144 

155.  Plaster  impression   of  four   abutments 147 

156.  Plaster  model  with  four  abutments 148 

157.  Abutments  removed  from  model  to  solder  wire  frame 149 

158.  Finished   frame  in  position 149 

159.  Finished  frame  for  another  case 150 

160.  Frame  and  Gilmore  Attachments  in  position  on  flasked  model   .      .  151 

161.  Other  half  of  flask 151 

162.  A  full  lower  Gilmore  denture 152 

163.  A   full   lower   Gilmore  denture  after   treatment 153 

164.  Full   upper    Gilmore    denture 153 

165.  Another  full  lower  Gilmore  case.     Finished  frame  on  model       .      .  154 

166.  Full    upper   Gilmore  denture.     Case  before   treatment 155 

167.  Same  case  with  finished  frame  in  position       ........  155 

168.  A  plaster  model  of  back  of  finished  denture 156 

169.  Case  of  a  patient  seventy-three  years  of  age 157 

170.  Full  lower,  with  two  roots  and  two  Gilmore  attachments  ....  158 

171.  Full  lower,  with  one  root,  using  two   Gilmore  attachments    .      .      .  158 

172.  Anterior  fixed  and  posterior  removable  bridge  with  Gilmore  attach- 

ments   160 

173.  Partial  removable  bridges  with  three  Gilmore  clasps 161 

174.  Removable  partial  bridge 162 

175.  Partial  lower  removable  gold  denture  held  with  one  Gilmore  attach- 

ment          163 

176.  Removable  bridge  with  vault  bar 164 


LIST  Ol'   ILLUSTIUTIONS  229 


K[G.  PACt: 

177.  Removable  bridge  held  Ity  three  Gihiiore  attachments 164 

178.  Partial   removable  bridge  with  vault   bar,   two  Gilmore   attachment?  165 

179.  Partial  removable  bridge  with  lingual  bar  and  two  Gilmore  attach- 

ments       165 

180.  Removable  extension  bridge  for  one  side 166 

181.  Top  view  of  finished  case   No.   180 166 

182.  Model  with  extension  wires  running  parallel ;   in  this  case  the  den- 

ture with  Gilmore  attachments  is  liable  to  slide  back    ....  167 

183.  Different    styles   of   Gilmore    Adjustable   Attachments 167 

184.  Roach  attachments  for  removable  bridges 168 

185.  Morgan   attachments   for   removable  bridges 170 

186.  Jig   for   Morgan  attachments 170 

187.  Morgan  attachments   soldered  to  all-metal  crowns 171 

188.  Morgan  attachments  used  on  various  crowns 171 

189.  Finished   case   of   Figure   187 172 

190.  Saddle  with  single  Morgan  attachments 172 

191.  Lower  denture  with  Morgan  attachments 173 

192.  Temporary   crowns 174 

193.  Old  crowns   and  bridges  after  they  have  been  taken   off   .      .      .      .  175 

194.  Old  bridges  with  posts  cemented  into  crowns  and  used  temporarily  176 

195.  S.   S.  White's  and  the  Giant  post  pullers 177 

196.  Ash  repair   facings 178 

197A.     Steele   repair   outfit 179 

197B.     Different   steps  to  repair  a  broken  pin   facing 180 

198A,   198B.     Bryant   repair  outfit 180,  181 

199.  Mineral  stains  and   stained   teeth 182 

200.  Measuring  distance  with  bridge  meter 183 

201.  Parallelism  obtained  with  the  Evslin  bridge  meter 183 

202.  Shows  condition  of  mouth 185 

203.  Radiographs   of  the   roots 185 

204.  Shows  impression  of  alnitments 1S6 

205.  Plaster  model  with  abutments  in  place 186 

206.  Articulated  models  with  face  bow  relation 187 


230  LIST  OF  ILLUSTRATIONS 


FIG.  PAGE 

207.     Bridge   teeth   waxed   for   trial 187 

208A.     Shows  crowns  held  in  plaster  core 188 

208B.     Shows  crowns  boxed 188 

209.  Sections  of  tooth  boxes  invested  and  ready  for  soldering   ....  188 

210.  Sections   united   to   abutments 189 

211.  Finished  fixed  bridge  with  teeth  cemented  into  boxes 189 

212.  213.     Harvard  Dental  School  case,  before  treatment 190 

214.  Radiograph  revealing  absence  of  permanent  teeth,  same  case   .      .      .  191 

215.  Same    case,    after    treatment 191 

216.  Pyorrhoea  case,  before   and  after   treatment 192 

217.  Same  case,  presenting  a   closed  bite.     Bite    was    raised    with    fixed 

bridges 192 

218.  Cast  inlays   for  same  case 193 

219.  Same  case,  before  and  after  treatment 193 

220.  Protruding  lower  teeth,  before  treatment ;  model  and  radiograph      .  194 

221.  Bridge    frame,   same    case 194 

222A,  222B.     Shows   frame  on  model  and  radiograph  of  frame  on  roots    .  195 

223.  Shows    upright  position   of   artificial   teeth •.      .      .  196 

224.  The  case  fiasked 196 

225.  Extra  wide  crowns  to  fill  space  of  median  line 197 

226.  Model   showing  efifect   of   lateral   tooth   dummy   with   porcelain   root 

after  six  years 197 

227.  Radiograph  of  same   case 198 

228.  Slotted  porcelain  tooth  with   root   and  pin  facing  with  root   .      .      .  198 

229.  Fractured  lateral   root  and   crown 199 

230.  Gold  inla}',  with  post  carrying  lateral  dummy  with  porcelain  root   .  199 

231.  Crown  and   Bridge   Case  VIII,  before   treatment,   showing   a  closed 

bite   due   to   poor  bridge   construction    . 200 

232.  Case  A^III,   before   treatment 201 

233.  Same  case,  after  treatment 201 

234.  Case  IX,  before  treatment 202 

235.  Case  IX,   after   treatment 202 

236.  Case  IX,   showing  lower 203 


LIST  OF  ILLUSTRATIONS  231 

FIG.  J'AGE 

237.  Case  IX,  showing  Irjwcr,   after  treatment;  two  sanitary  Ijridges  .      .  203 

238.  Case  IX,  showing  upper,  before  treatment 204 

239.  Case  IX,    after    treatment 204 

240.  Case  IX,  before  treatment 205 

241.  Case  IX,    after    treatment 205 

242.  Case  X,   before   treatment 206 

243.  Case  X,  after  treatment 206 

244.  Case  X,  before  treatment 207 

245.  Case  X,  after  treatment 207 

246.  Case  X,   before   treatment 208 

247.  Case  X,    after    treatment 208 

248.  Case  X,   before   treatment 209 

249.  Case  X,  after  treatment 209 

250.  Case  XI,  before  treatment,  showing  close  bite 210 

251.  Case  XI,  after  treatment,  showing  raised  bite 210 

252.  Case  XI,   showing  bridge   in   place 211 

253.  Case  XI,    showing  bridge   in   place 211 

254.  Case  XI,    finished 212 

255.  Case  XII,   before   treatment 213 

256.  Case  XII,  after  treatment 213 

257.  Case  XIII,   before   treatment 214 

258.  Case  XIII,   after  treatment 214 

259.  Case  XIII 215 

260.  Case  XIII 215 

261.  Case  XIII,   before   treatment 216 

262.  Case  XIII,  after  treatment 216 

263.  Case  XIII 217 

264.  Case  XIII     . 217 

265.  Case  XIII,   before   treatment 218 

266.  Case  XIII,   after  treatment 218 


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